Care Management NP - Michigan

Signify Health Kalamazoo , MI 49001

Posted 4 months ago

Position Overview:

Signify Health seeks Advanced Practice Registered Nurses with expertise in geriatrics, experience working in multidisciplinary teams, ability to practice autonomously, and the desire to make a difference in people's lives. While there are many goals of this program, the overriding goal is to improve the quality of life for the member by reducing unnecessary hospitalizations and emergency rooms visits.

Signify Health is focused on improving the quality of life for Health Plan Members through health assessments, effective care coordination, and best in class care management. The Signify Health Care Management Program is for health plan members residing in long term care facilities.

Qualifications:

Education/Licensing Requirements:

  • APRN with license in good standing in the applicable states

  • Active DEA License or the ability to get a DEA License

  • One or more years as NP Preferred

  • Family Medicine, Geriatrics, and Psychiatric Nurse Practitioners are encouraged to apply

  • Nurse Practitioners fluent in Spanish are encouraged to apply

Role and Responsibilities:

  • Complete an hour long assessment of patient including:

  • Provide a complete physical assessment and history of current and previous illness(es)

  • Drug reconciliation and education

  • Determination of their caregiver support

  • Assess activities of daily living, depression screening, and other tools

  • Create a plan of care

  • Weekly or bi-weekly follow up calls with members and/or caregivers

  • Weekly or biweekly follow up calls with appropriate medical staff

  • Weekly rounding with the Signify Health Clinical team

  • Monthly or bi-monthly follow up visits with members

  • On-call approximately every ten days to receive calls and occasionally provide emergency visits (these visits are relatively rare and are separately compensated to reward you for taking care of the member)

  • Conduct readmission prevention visits with member within 48 hours of discharge

Essential Characteristics:

  • Strategic thinker

  • Detail-oriented

  • Ability to handle routine tasks

  • Self-directed and organized

  • Sound judgement in handling/escalating difficult situations

  • Sense of urgency

  • Good interpersonal and conflict resolution skills

  • Discrete (i.e., ability to maintain confidentiality)

  • Team player

  • Ability to work under pressure

  • Ability to take direction

Essential Job Responsibilities:

  • Conducting regular in person follow-up with members and/or caregivers, as well as appropriate medical staff based on care needs identified during clinical assessments.

  • Partnering with the Signify Health, health plan, and providers to help coordinate both internal and external resources to meet the member's identified needs and to manage the member's Plan of Care.

  • Quickly respond to urgent/emergent conditions and hospital admissions to ensure that the member receives the appropriate care in the appropriate setting.

  • Assist with improvement to work processes and commits to a focus on continuous improvement of workflow processes and procedures.

  • Attends meetings, training sessions, and participates on committees as requested.

  • Knowledge of clinical procedures, standards, and quality control checks.

  • Must possess strong critical thinking skills.

  • Strong knowledge of medical conditions, interventions, treatment, and medications.

  • Ability to effectively present information and respond to questions from members, providers, team members, and managers.

  • Provides member, caregivers, and facility education.

  • Monitors the quality of member's care and updates Plan of Care.

  • Identifies / implements cost-effective approaches and interventions.

  • Performs other related duties and responsibilities as assigned.

Additional Job Responsibilities:

  • Participate in staff meetings, conference calls, and other meetings, as needed

  • Complete reports as requested

  • Assist/coach/coordinate with other team members

  • Maintain a neat, orderly work area

  • Perform other incidental and related duties as required

  • Maintain APRN License, including Continued Medical Education

  • Maintain active DEA license

Working Conditions:

  • Fast-paced environment

  • Requires the ability to also conduct in-person visits in the field

  • Normal sight and hearing ability

  • Use office equipment and machinery effectively

  • Ability to ambulate to various parts of the building

  • Ability to bend, stoop

  • Work effectively with frequent interruptions

  • May require occasional overtime to meet project deadlines

  • Lifting requirements of 15 lbs. occasionally

Equipment Provided:

  • An iPad to perform the assessment

  • iPad that houses the assessment templates.

  • Our iPads do NOT require internet connection to complete the HRA paperwork.

  • Providers may log in to the app, enter the information received from the member into the assessment.

  • Online scheduling system called ATLAS that our Providers log on to from their iPads to view their schedule for the next two to three weeks.

  • In the schedule, for each block of time we include the following: Member's name, Phone number & nursing home Address.

  • Travel time so you will know exactly how long it will take to get from one location to the other

  • We have an entire department that caters to our NPs schedules, they are 'Provider Services'.

  • NP's will have one point of contact with all of their questions or concerns related to the visits.

  • All providers get a Signify Health email account for all company communications that are not via telephone

  • All providers receive a contact list upon hire with all relevant phone numbers and contacts

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Care Management NP - Michigan

Signify Health