The ConcertoCare Advanced Practice Provider delivers in-home clinical services to patients with the support of an integrated multidisciplinary care team. Our Advanced Practice Providers build meaningful relationships with patients and their caregivers, managing your patient’s clinical conditions in their homes or place of living, supporting them to provide care aligned with what matters most to our patients and championing patient-centered strategies that guide our care teams. This is an ideal position for a clinician who seeks an opportunity for “top of license” complex primary care practice, enjoys a collaborative team-based approach to care, and is excited to engage in developing and nurturing our innovative, value-based clinical model focused on caring for patients with complex needs who are inadequately served by traditional healthcare delivery systems.

This exciting role allows you to deliver clinical care through a blend of in-person care delivery at your patient’s home and virtual care delivery from your own home. You will work closely with our team of exceptional nurses, community health workers, medical assistants, nurse case managers, clinical social workers, and clinical pharmacists. This position also affords professional development via dedicated clinical education programming and real-time support from our on-staff world-class experts in geriatric medicine, palliative care, geriatric psychiatry, clinical pharmacy, care management, and social determinants of health and health equity.

Responsibilities:

• Provision of compassionate, individualized, and holistic patient care including comprehensive care, urgent care, and chronic condition management that aligns with a patient’s goals, value-based care delivery model, reflects appropriate patient risk stratification, integrates with multidisciplinary team services, and identifies and addresses gaps in care.
• Assess patients in a home setting, where rapid access to diagnostics and imaging may be limited. Use your primary care clinical knowledge, generate an appropriate differential diagnosis, engage with the patient in the workup and treatment plan, and effectively communicate this plan to the patient, caregiver, PCP, and interdisciplinary team.
• Collaborate with the multidisciplinary team to cooperatively deliver transitions of care support, social determinants of health interventions, behavioral health evaluation and management, and complex medication management as clinically appropriate.
• Build, and maintain patient, caregiver, guardian, PCP, and specialist relationships, to facilitate disease management as quickly as possible.
• Deliver exceptional clinical care both in-person and virtually, with in-person settings including private homes, congregate living facilities, ambulatory clinics, and/or skilled nursing facilities.
• Integrate clinical practices, data dashboards, and operational processes that support the achievement of company performance goals into daily clinical approaches and workflows.
• Promote and participate in patient engagement and experience initiatives and efforts.
• Maintain comprehensive medical records including timely and accurate completion of clinical documentation and coding for clinical encounters, up-to-date medication reconciliation, and recording of patient care-related activities and communications.
• Add value in care team huddles, operational huddles, organizational meetings, and clinical partnership meetings as requested including preparation and follow-up activities.
• Engage with internal care team members as well as external providers and clinical partners to support care coordination including goals of care.
• Adhere to medical policies, protocols, criteria, and clinical guidelines to ensure best practices are maintained for clinically effective and efficient care delivery.
• Adhere to compliance policies, procedures, and standards of conduct including all applicable laws and regulations.
• Support function as growth/engagement ambassador in initiating, developing, and sustaining relationships with patients, caregivers, congregate living facility staff, and clinical partners.
• Participate in after-hours on-call schedule and other clinical care cross-coverage as requested.
• Other market-specific duties as assigned.

QUALIFICATIONS

• Bilingual English/Spanish preferred.
• Nurse Practitioner or Physician Assistant with graduation from an accredited health professions school and active national board certification.
• Active licensure in the state of California.
• Active DEA licensure and state-specific controlled substance registration, as applicable.
• A minimum of 3 years of experience is required, in-home/virtual experience is preferred.
• Advanced training in geriatrics and/or palliative medicine is preferred.
• Certification in basic life support (BLS) is required.
• Clinical experience caring for aging adults and adults with complex care needs is required.
• Clinical experience caring for patients in the home setting including private homes and/or congregate living facilities preferred.
• Previous experience with managed care and/or value-based healthcare delivery is preferred.
• Average to advanced computer and software skills are required.
• Ability and means to travel as needed in a timely manner to locations that may have limited access to public transportation; proof of liability and property damage insurance on the vehicle used is required. DRIVER REQUIREMENTS: Licensed for a minimum of 3 5 years. No vehicle-related suspensions/reinstatements, DUI, reckless driving, or felony convictions within the last 7 years. Multiple violations and accidents within the last 5 years would be subject to review.

Base Salary/ Wage Range $130,000 to $160,000 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.

ConcertoCare requires all “frontline workers” to be fully vaccinated and to provide records for validation. Medical or religious exemptions will be considered contingent upon the review of appropriate documentation.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace