Primary Care Nurse Practitioner (NP) - Mercer County

MEET CLOVER HEALTH HOME CARE

Clover is reinventing health insurance by working to keep people healthier.

Our Complex Care Team is a group of caring and passionate professionals dedicated to improving the lives of our most vulnerable members. Our team includes physicians, nurses, social workers, medical assistants, behavioral health specialists and others who provide in-home primary care and transitional care services. A goal for this program is to improve our offering of palliative and supportive care services for members with advanced illness.

Our leading complex care offering is the Clover In-Home Care program. This program provides vulnerable members, including those with major complex chronic conditions, frailty, and advanced illness, with in-home primary care services from an interdisciplinary team. Our providers are trained in geriatrics and supportive care and are able to focus on the symptoms and conditions that matter most to complex older adults.

The primary care provider (PCP) is a nurse practitioner (NP) specializing in family medicine, internal medicine, and/or geriatric medicine, and who provides primary care to an assigned panel of patients in accordance with licensure, privileges, and scope of practice.

In collaboration with the Patient Care Team (PCT) composed of nurses, medical assistants, and social workers, the PCP is responsible for the following:

• Assuming primary medical responsibility for their assigned patients.
• Visiting patients at home.
• Providing person-centered care by eliciting patients’ values and preferences and structuring care plans to reflect these desires.
• Routinely determining patients' prognoses and structuring care plans, including advanced care planning, to reflect these prognoses.
• Routinely determining primary drivers of hospitalization risk and structuring care plans to minimize these risks.
• Achieving high performance on CMS and NCQA-determined Stars and HEDIS quality metrics, respectively.
• Providing care that is consistent with medical evidence, including identified clinical protocols.
• Identifying obstacles to care and medical decision-making and collaborating with the larger PCT to address these obstacles.
• Leading interdisciplinary team (IDT) meetings.
• Ensuring execution of member care plans by the PCT through clinical personnel supervision and education and training.
• Determining the need for consultation from medical, surgical, rehabilitative, and/or psychiatric specialties.
• Determining the need for and facilitating care by an emergency department, hospital, skilled nursing facility, home health agency, hospice and/or community-based organization as appropriate and consistent with patients’ goals of care.
• Providing medical administrative support such as signing forms requiring physician signature.
• Documenting all clinical encounters in a timely and accurate manner, including in proprietary Clover tools such as Clover Assistant.
• Participating in ongoing professional development and self-improvement.
• Collaborating with the practice Medical Director and Practice Manager in efforts of continuous quality improvement, including that related to the EHR and Clover Assistant .
• Collaborating with the practice Medical Director and Practice Manager in efforts to pilot new care delivery models.
• Supporting Clover’ efforts to establish a positive image for the In-Home Care practice in the medical community.

You will love this job if:

• You are passionate about caring for our most vulnerable elders, including those with multiple chronic conditions, frailty, and advanced illness.
• You enjoy team-based collaborative care.
• You love developing relationships with your patients and their caregivers.
• You embrace technology and clinical protocols as a means for driving high quality clinical care.
• You are flexible and comfortable working in an evolving environment that values innovation.
• You embrace measurement and performance management to drive improved member outcomes.

You should get in touch if:

• You are based in Mercer County, New Jersey (required).
• You are certified as an Advanced Nurse Practitioner (required).
• You hold current unencumbered NJ Licensure as a Registered Nurse.
• You graduated with a Bachelor’s degree (BSN) from an accredited school of nursing.
• You have an active DEA and CDS registration.
• You have a Master’s degree in advanced clinical practice nursing o