Position Summary:
The Jump Start Assessment program is a physician-led and advanced practice clinician-driven program that is intended to care for and support patients with complex and chronic care needs. As a JSA Advanced Practice Clinician, you will work within an interdisciplinary team environment that includes physicians, nurse practitioners, physician assistants, case managers, and other health care team members to ensure proper delivery of clinical and home-based patient care. In this role, you will assess, develop, and coordinate options and services promoting quality care in order to achieve optimal health care outcomes while also ensuring cost-effective care complying with policy and all state and federal regulations. Our members are typically aged 65 and over and home and virtual visits will be between 45 and 60 minutes depending on whether it is an annual or initial visit.

General Duties/Responsibilities:

(May include but are not limited to)

JSA APC’s responsibilities

• Conduct initial or annual face-to-face patient visits in home and clinic settings
• (Follow CMS guidelines to make virtual visits when appropriate)
• Health Risk Assessment includes:
  • Past medical history
  • Review of symptoms
  • Physical examination
  • Medication review
  • Cognitive/depression screenings
  • Fall assessment/functional assessment
  • Immunizations and preventive health screenings including Colonoscopy, Breast Cancer screening, Bone density, and diabetes eye exams
  • Advance Care Planning and POLST
• Update and reevaluate the year-to-year diagnoses following CMS guidelines and HCC coding
• Identify diagnoses and develops proper care plan for chronic disease management
• Provide patient/family/caretaker education and facilitate patient empowerment and quality of life
• Matching care desired with care given while providing true, informed consent
• Collaborate with HEDIS/STARS and other Alignment programs and departments to facilitate optimal program integration and continuity of care
• Refer patient to an appropriate program such as Care Anywhere Program
• Refer patient to social worker for appropriate community resources as needed
• Provide contact information for patient to receive medical assistance to avoid unnecessary emergency room visit and hospitalization
• Comply with all HIPAA regulations and maintains security of protected health information (PHI)
• Complete EMR documentation with quality that meets Alignment expectations in a timely manner.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

• Computer literacy/EMR proficiency
• At least one (1) year prior clinical experience

Education/Licensure:

• Active California state license as a Nurse Practitioner/Physician Assistant
• Active Nurse Practitioner/Physician Assistant Board Certification
• Medicare Part D Prescriber
• Valid California driver license and current automobile insurance
• NP (Nurse Practitioner):
• Active RN License (Must, upon hire)
• Active NP License (Must, upon hire)
• Furnishing number (Must, upon hire)
• NPI Number (Must, upon start)
• DEA Number (Must, within 6 months of start)
• Board Certification: AANP, ANCC (Must, within 6 months of start)
• Valid BLS (Basic Life Support) (Must, upon start)
• Valid ACLS (Advanced Cardiovascular Life Support (Preferred)

PA (Physician Assistant):

• Active PA License (Must, upon start)
• NPI Number (Must, upon start)
• DEA Number (Must, within 6 months of start)
• Board Certification: NCCPA (Must, within 6 months of start)
• Valid BLS (Basic Life Support) (Must, upon start)
• Valid ACLS (Advanced Cardiovascular Life Support (Preferred)

Other:

• Knowledge of current clinical standards of care
• Ability to work independently
• Excellent communication skills, especially with older adults
• Good time management skills
• Experience in care of older adult (geriatric) patients preferred
• Home care experience preferred
• Computer literacy/EMR proficiency

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

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