ABOUT ADOBE
Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 committed to positively impacting the lives we touch. The company has a culture of inclusivity and human kindness, based in Phoenix, AZ, with satellite locations in multiple states. APH has been recognized the last two years as one of “America's Fastest-Growing Private Companies” by Inc. 5000 and has earned a "Best Places to Work" award from the Phoenix Business Journal four years in a row.
As one of the country's few fully integrated healthcare providers, APH offers a range of services which include case management, in-home/in-clinic wellness assessments, preventative care, transitional care, and social work services. APH offers customized services for Medicaid, Medicare, and the ACA/Marketplace lines of business.
POSITION PURPOSE
As a Complex Care Provider, you will deliver exceptional remote care via our telemedicine platform in a compassionate manner. In this team-based model, you will be a licensed Nurse Practitioner (NP), Physician Assistant (PA), or Medical Doctor (MD/DO) who is a key member of the Population Health team, dedicated to delivering comprehensive, patient-centered care for adults with complex medical, emotional, and social needs, as well as chronic, acute, preventive, and palliative care needs. Supported by nurses in the field and a robust administrative team, you will leverage telemedicine tools to deliver high-quality, patient-centered care. This role emphasizes longitudinal care, preventive and chronic disease management, and innovative approaches to address health disparities and improve patient outcomes.
DUTIES & RESPONSIBILITIES
Care Coordination
- Develop and implement individualized care plans in collaboration with patients, families, and interdisciplinary team members.
- Coordinate care across primary care, specialty providers, behavioral health, and community resources.
- Facilitate transitions of care to prevent readmissions and ensure continuity.
- Diagnose, assess, and treat a variety of medical conditions, particularly those related to chronic health issues.
- Develop and implement individualized care plans that address physical, emotional, and social needs.
Patient Care
- Provide clinical care, including assessment, treatment, and monitoring of acute and chronic conditions, adhering to evidence-based guidelines.
- Provide comprehensive care for an adult patient panel, including chronic condition management, preventive care, and acute or palliative care as needed.
- Perform in-home visits, telehealth, and clinic-based care to meet patient needs.
- Offer patient education on disease management, medication adherence, and preventive health.
Behavioral and Social Support
- Address behavioral health concerns by collaborating with mental health professionals and integrating behavioral health into care plans.
- Identify and mitigate social determinants of health, such as housing instability, food insecurity, and transportation barriers, by connecting patients with community resources.
- Engage in longitudinal care, building relationships with patients and managing their health over time.
- Engage in population health initiatives, using data to identify trends and develop strategies to improve care delivery.
Data and Quality Improvement
- Track and document patient outcomes to assess the effectiveness of interventions.
- Participate in quality improvement initiatives aimed at reducing disparities and enhancing care delivery.
- Utilize population health data to identify at-risk individuals and proactively manage their care.
- Utilize telemedicine technology for video consultations, EHR documentation, and patient interactions.
- Innovate and adapt to novel care models that meet the complex medical and social needs of patients.
Collaboration and Communication
- Work closely with interdisciplinary teams, including physicians, nurses, social workers, and case managers, to ensure comprehensive care, seamless scheduling, records retrieval, and rapid check-ins.
- Communicate effectively with patients and families, respecting their cultural, linguistic, and personal preferences.
- Collaborate with field-based nurses to deliver integrated care and support patient self-management skills.
On-Call Requirements
- This position requires participation in an on-call rotation to provide support outside of standard business hours.
- Responding to urgent issues or emergencies as they arise.
- Being accessible and available via phone, email, or other designated communication tools during on-call shifts.
- Addressing incidents or escalating them as necessary to ensure timely resolution.
- Maintaining documentation of on-call activities and resolutions.
- On-call shifts may include evenings, weekends, and holidays, as determined by the department schedule. Candidates must demonstrate flexibility and the ability to adapt to unexpected situations during on-call periods.
SKILLS & QUALIFICATIONS
- Minimum of 3 years of clinical experience with strong clinical skills, with a focus on complex care or population health.
- Experience in primary care, preferably with geriatric and palliative care patients.
- Proven ability to manage a patient panel and provide longitudinal care.
- Comfortable collaborating with nurses and other team members in the care process.
- Compassionate and empathetic, with a commitment to serving patients with complex medical and social needs.
- Organized, flexible, and innovative with a problem-solving mindset.
- Proficient in telemedicine technology, including EHR systems and videoconferencing platforms.
- Spanish language skills preferred but not required.
EDUCATION, LICENSES, & CERTIFICATIONS
- Active and unrestricted licensure as a Nurse Practitioner (NP), Physician Assistant (PA), or Medical Doctor (MD/DO) in the state of California is REQUIRED.
- Board Certified or Board Eligible in Internal Medicine, Family Medicine, or Geriatrics is preferred.
- Familiarity with telemedicine platforms and digital health tools.
BENEFITS & TOTAL REWARDS
- Paid Orientation and Training
- 401k Plan – 3% match
- Employee Assistance Program
- Mileage Reimbursement (if applicable)
- Referral Bonuses
- Paid Time Off (5 days)
- Paid Volunteer Hours
CHARACTER & COMPETENCIES
- Courage – To have the courage to the right thing at the right time.
- Ownership – To take ownership of every issue you touch.
- Respect – To respect yourself, co-workers, and for those whom you care.
- Excellence – To be excellent in all that you do.
- Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
- Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
- Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
- Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
PHYSICAL DEMANDS & WORK ENVIRONMENT
- Occasionally required to stand.
- Occasionally required to walk.
- Continually required to sit.
- Occasionally required to climb, balance, bend, stoop, kneel or crawl.
- Continually required to talk or hear.
- While performing the duties of this job, the noise level in the work environment is usually moderate.
- May occasionally lift and /or move more than 30 pounds.
- Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing.
EQUAL EMPLOYMENT OPPORTUNITY
APH is an Equal Opportunity Employer where all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.