Full Job Description
General Purpose: The individual in this position must actively uphold and exemplify Longevity Health’s commitment to improving the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.
The Advanced Practice Provider (APP) will be assigned to a specified geography and will be responsible for comprehensive medical assessment and documentation for all beneficiaries in the CareOne ACO, powered by Longevity Health. The APP works in partnership with contracted provider groups as an additional resource for eligible beneficiaries. The APP conducts comprehensive assessments at initial alignment, bi-annually, and as necessary with transitions in the beneficiary’s care. The APP also helps support provider groups with advanced care planning and care transitions in the participating nursing homes.
Key Tasks and Responsibilities:
- The APP will complete the initial and/or annual wellness visit (AWV) and/or complete medical visit (comprehensive) every 6 months and as needed with care transitions.
- Collaborate with primary provider group on beneficiary medical management needs including, but not limited to:
- Prevent avoidable hospitalizations
- Develop and update goals of care/advanced care plan (ACP)
- Manage care transitions; both acute and chronic
- Medication reconciliation and readmission requirements per SNF needs
- Specialty appointment recommendation approval
- Part A /Part B management in SNF (3-day hospital stay may be waived depending on convener)
- Acute exacerbations of chronic condition member visits within 72 hours (In facility, hospital or ED/observation)
- Ensure appropriate health care utilization
- Specialty services management-wounds, psych, labs/radiology, behavioral health
- Palliative and hospice support
- Advanced care planning/review monthly with every regulatory visit
- Visit member at minimum per nursing home regulation and with any beneficiary change in condition *if PCP group not medically managing
- Ensure appropriate focus on identifying patients who should be on a palliative or hospice plan of care on a regular basis ensure patient orders and advanced directives are in alignment with goals of care
- Aid in value-based medicine provider group continued coaching and mentoring including:
- Coaching through difficult cases
- Mentoring on nursing home internal medicine, treating in place, palliative approach, hospice, and end of life management
- ACO APP available for telephonic support during LH regular business hour
- Serves as a trusted advisor to beneficiaries, loved ones and nursing home staff and provider groups, educates care teams on beneficiary needs and early identification of changes in condition, notifying provider group and telehealth partners for beneficiary changes.
- Mentoring on nursing home internal medicine, treating in place, palliative, hospice, and end of life management.
- ACO APP will be available for telephonic support during LH regular business hours.
- Serves as a trusted advisor to beneficiaries, loved ones and nursing home staff and provider groups, educates care teams on beneficiary needs and early identification of changes in condition, notifying provider group and telehealth partners for beneficiary changes.
- Promotes Longevity Health with beneficiaries, loved ones and nursing facilities and other stakeholders.
- Establishes meaningful relationships and can effectively function in the nursing home environment.
- Is resident-centric and customer service oriented, establishing meaningful relationships that ensure effective and high-quality care for Longevity Health beneficiaries.
- Performs other related duties as assigned.
Credentials & Coverage:
- State unrestricted licensed Advanced Practice Nurse, National Board certification (AANP, ANCC or AACN) as an Adult, Family, Geriatric or Primary Care nurse practitioner required. Will allow acute care nurse practitioner with nursing home/geriatric or hospice palliative experience OR state unrestricted licensed Physician’s Assistant NCCPA board certified with nursing home/geriatric or hospice/palliative experience.
- Active DEA license required.
- Must have an active national provider number (NPI) and an active Medicare provider number.
- Must be eligible to participate in the Medicare program as a provider and registered.
- Valid state driver’s license with a good driving record and proof of automobile insurance required.
- Auto liability insurance declaration page with minimum limits of $100,000/$300,000 for bodily injury and $100,000 for property damage with combined single limit of $300,000. You will be responsible for providing this proof of coverage annually. Newly onboarding employees to this job description should contact HR to discuss any adjustments required to meet this coverage.
Education and Training:
- Master of Science in Nursing as a Nurse Practitioner from a nationally accredited program OR Master’s Degree from a nationally accredited program.
Knowledge and Experience:
- Minimum of 6 months experience as a Nurse Practitioner/Physician’s Assistant AND has some experience with geriatric/hospice or palliative care population prior to becoming an NP/PA OR is a licensed and board-certified new graduate NP/PA supervised by an experienced NP/PA in the Longevity Health New Graduate Fellowship program for 6 months and successfully completes all competencies for independent practice as a Longevity Health CareOne ACO APP.
- Experience working in the nursing home environment is strongly desired.
- Computer/Technology proficiency required.
- The ability to engage and communicate effectively with physicians, patients, family members— excellent people skills.
- Self-directed but functions well in a team environment.
- Excellent clinical skills—assessment, diagnosis, treatment, prescribing specifically for the chronically ill population.
- Can function independently, demonstrated critical thinking skills, organization, and prioritization skills.
Company Overview:
Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes. Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina.
In 2023, we expanded our service offerings to the broader health plan market. In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.
Company Disclaimers:
Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations. While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve. If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination. To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site.
The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.
Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.
Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).
Submission of false information during the application process may result in immediate termination of employment without notice.