Geriatric Advanced Practice Provider

Medical Home Network • Springfield, MO

3d • Onsite

About The Position

Medical Home Network is seeking a Geriatric Advanced Practice Provider to deliver high-quality, patient-centered care to an aging population and help build, implement, and scale clinical programs focused on preventive care, wellness, care coordination, and age-friendly care models. The provider will deliver billable clinical services in collaboration with contracted health centers, including Medicare Annual Wellness Visits (AWVs) and Advance Care Planning (ACP) discussions, while contributing to program design, best practices, and continuous improvement. The role brings specialized geriatric expertise to community health centers that traditionally lack dedicated geriatric services and supports MHN’s broader care delivery initiatives by guiding care management and comprehensive, compassionate patient care.

The position works onsite at partner health center locations in Springfield and Decatur, Illinois. It includes direct management of Medical Assistant(s) and collaboration with physicians, nurses, care managers, social workers, operations, clinical leadership, and quality teams.

Requirements

• Active Nurse Practitioner license in Illinois; the posting also requires a current, unrestricted NP or PA license in Illinois.
• National NP certification (AANP or ANCC) or PA certification.
• Experience in geriatric care.
• Demonstrated experience conducting Annual Wellness Visits and Advance Care Planning discussions.
• Strong communication skills and comfort with sensitive conversations.
• Master’s degree or higher from an accredited Nurse Practitioner or Physician Assistant program.

Nice To Haves

• Experience working in FQHCs or similar community health settings is strongly preferred.
• Prior experience building or scaling clinical programs.
• Experience with primary care or population health.
• Background in value-based care, risk adjustment, or quality initiatives.
• Familiarity with EHR documentation and Medicare compliance.
• Experience working with interdisciplinary or care management teams.
• Fluent Spanish speaker.

Responsibilities

• Provide comprehensive primary and preventive care to aging patients enrolled in MHN-contracted health centers.
• Assess chronic disease management, functional status, cognitive health, fall risk, and medication management needs.
• Develop individualized, patient-centered care plans with patients, caregivers, and interdisciplinary teams.
• Conduct Medicare Annual Wellness Visits, including health risk assessments, cognitive and depression screenings, fall risk and functional assessments, medication reconciliation, preventive care planning, and referrals.
• Document care accurately and comply with regulatory and payer requirements.
• Identify gaps in care and initiate appropriate follow-up or care coordination.
• Lead patient-centered Advance Care Planning discussions with patients and families, assessing goals, values, and preferences for future medical care.
• Facilitate completion and documentation of advance directives, POLST/MOLST forms, and related ACP documentation as appropriate.
• Coordinate with care teams to ensure ACP preferences are understood and honored across care settings.
• Contribute to the design, implementation, and scaling of clinical programs focused on geriatric care, preventive services, and population health.
• Help define workflows, clinical protocols, and quality standards for AWVs, ACP, and related initiatives.
• Partner with operations, clinical leadership, and quality teams to improve efficiency, outcomes, and patient experience.
• Support quality improvement initiatives, documentation accuracy, and value-based care performance metrics.
• Educate patients, caregivers, and staff on preventive care, aging-related health topics, and care planning.
• Directly manage Medical Assistant(s).

Benefits

• Paid time off
• Sick time
• 12 paid holidays
• Collaborative work environment with colleagues passionate about healthcare delivery
• Recognition as one of Modern Healthcare’s Best Places to Work in Healthcare

What This Job Offers

• Job Type: Full-time
• Career Level: Senior