AE - Value Based Care Nurse Practitioner

Job Description

Job Title:  Value Based Care NP

Reports to: Medical Director- Value Based Care

Department: Value Based Care Program

FLSA Status:  Exempt

Job Grade:  P

Version Date: April 2023                                                   

General Responsibilities:

General Responsibilities: The Value Based Care Nurse Practitioner (VBC NP) is a member of the Integrated Care Management department; a multi-disciplinary team comprised of nurse care managers, community health workers, behavioral health clinicians, and peer recovery support specialists. The VBC NP is responsible for providing primary medical care as a home-based extension of the primary care provider care teams, within the limits of the training of a Nurse Practitioner to patients referred to the home-visiting program and integrated care management team. In addition, the VBC NP also is responsible for performing Medicare Annual Wellness Visits. The VBC NP may also be assigned to perform duties at Thundermist Medical Respite and other Thundermist activities that are supported by the Thundermist Accountable Entity. The VBC NP is a licensed, autonomous provider executing professional clinical judgment in the care of his/her patients according to the guidelines, policies and procedures set forth by the agency.

Qualifications:

Required Qualifications: 1. Rhode Island RN and APRN licensure 2. ANA Certification in Family Medicine or Adult/Geriatrics 3. Ongoing CEU to update skills/therapies. 4. Ability to work independently and effectively in a team environment. 5. Ability to work in the community assigned (either Woonsocket or West Warwick/South County) and travel within and around that community. 6. Valid driver’s license and reliable transportation with proof of RI minimum requirements of auto insurance (including a 100/300 K Rider) to utilize your automobile for work purposes. 7. Bi-lingual desirable. 8. BLS Certification

Significant Job Functions:

1. Convey the organization’s mission and vision to audiences inside and outside of the health center to increase patient volume and satisfaction and enhance understanding of and promote programs, services, and initiatives.
2. Act as the organization’s representative with the media, developing relationships with media staff (newspaper, television, and radio).
3. Responsible for the editorial direction, design, production, and distribution of all agency publications and digital content. 
4. Manage multiple projects with strict deadlines. Projects in this area can be cross-organization requiring leadership of others who you may not supervise. 
5. Maintenance of social media, website and intranet information and responses.
6. Develop marketing efforts to enhance the agency’s standing in the community and support goals outlined in Thundermist’s strategic plan.
7. Support agency operations with media advertising designed to raise awareness of new or existing services.
8. Provide outstanding customer services to internal customers.
9. Collaborate closely with the human resources department to develop an internal communications strategy that advances the organization’s strategic plan.
10. Work collaboratively with president/CEO and chief of staff to drive the content of the internal communications plan.
11. Plan and execute employee events with assistance of communications specialist.
12. Gain a deep understanding of the organization’s mission, strategic plan, and potential for growth.
13. Lead and mentor the marketing and communications team with an eye toward excellence and professional growth.
14. Clinical 1. Patient Care – history, physical exam, management of acute and chronic illness of high-risk adults with complex chronic health conditions. There will be three primary types of visits:

1. Providing high quality home-based and medical respite care for medically complex patients who are experiencing temporary or long-term physical or behavioral health issues impacting their ability to be seen in an office-based primary care setting.
2. Supporting recently hospitalized patients as they transition home by performing post-discharge home or medical respite visits to reconcile medications, assess patient’s clinical status, and ensure that they have access to all necessary home services.
3. Providing Annual Wellness Visits onsite in either Woonsocket or West Warwick/South County.

      15. Maintenance of complete and accurate patient records. Completion of medical notes in a timely manner                    f           for claims processing. Administrative

Primary Contacts: External: Frequency: 1. Hospitals Daily 2. Providers Daily 3. Outside Agencies Daily 4. Laboratory Staff 5. Patients in their home Daily Daily Internal: Frequency: 1. Patients Daily 2. Providers/PCP Daily 3. Staff and Medical Staff Daily 4. Members of ICM Team Daily 5. Administrative Staff Periodically

Physical Effort/Environment: Moderate physical activity; walking, standing, and stooping. May require climbing several flights of stairs and carrying personal technology such as laptop and small clinical equipment. Must be comfortable entering and providing care within the home environment of patients. Travel within Rhode Island and surrounding areas with heavy focus on Woonsocket, West Warwick, and South County. Potential exposure to bloodborne pathogens, respiratory disease, and other infectious diseases, and other biohazardous materials requiring universal standard precautions for medical practitioners. Manual dexterity needed for certain medical procedures.

Work Schedule Demands:

16 Home Visiting Hours/Week with 4 hours of administrative time; 14 hours per week of Annual Wellness Care Time/week with 4 hours of administrative time. In addition, 2 hours per week will be devoted to meetings around the Medicare and Medicare Value Based programs for a total of 40 hours per week.

Communication Skills:

• Exceptional oral and written communication skills needed. Proficiency in all applicable medical terminology. Bilingual capacity in Spanish is a plus. Strong interpersonal skills are needed.

Confidentiality of Information:

Thundermist is dedicated in securing the privacy and confidentiality of protected health information under the Health Insurance Portability and Accountability Act. It is the responsibility of all employees to comply to state and federal guidelines in accessing sensitive information. Additionally, this role will have access to sensitive agency information. The incumbent must apply strict confidentiality.

ADA & EEOC Statement:

Thundermist is dedicated to the goal of building and maintaining a diverse and inclusive workforce committed to caring for patients in a manner that is respectful of cultural difference. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.