The clinician performs brief telehealth intake visits for older adults to establish medical necessity for care navigation services, identify high-risk conditions, and uncover unmet social needs. This role also involves reviewing and approving individualized care plans, documenting clinical findings and SDOH-related information, and coordinating with care advocates and nurse care managers. The work is fully remote and supports a tech-enabled, integrated model of clinical oversight plus social support.
Key Responsibilities
- Conduct structured telehealth E/M visits and Annual Wellness Visits to determine eligibility for care navigation services.
- Identify high-risk medical conditions, care gaps, and unmet social needs during intake assessments.
- Document findings in the care platform with accurate coding, diagnoses, risk factors, and SDOH Z-codes.
- Develop and approve individualized care plans aligned with the patient’s medical treatment plan and documented medical necessity.
- Collaborate with care advocates and nurse care managers to coordinate safe, compliant enrollment into services.
Required
- Completion of an accredited Nurse Practitioner program.
- Active Nurse Practitioner or APRN license in good standing.
- Multi-state licensure.
- At least 2 years of experience in primary care, telehealth, or care management.
- Bilingual Spanish proficiency.
Preferred
- Familiarity with Medicare programs, including care navigation and incident-to requirements.
- Experience documenting social determinants of health.
- Proficiency with EMRs, care management platforms, and telehealth workflows.
Benefits & Perks
- Remote, flexible 1099 contractor work.
- Opportunity to support older adults across assisted living, nursing home, and home settings.
- Work within a tech-enabled care advocacy model.
- Collaborate with advocates and clinical operations staff in a coordinated support model.