Hybrid APC Provider- Detroit, Michigan

Cityblock Health•Detroit, MI

2d•$97,000 - $128,000•Hybrid

About The Position

The Pod Provider delivers comprehensive chronic disease management (e.g. hypertension, diabetes, chronic kidney disease), evaluation of acute concerns, behavioral health condition management (i.e. depression, anxiety, alcohol and substance use disorder), and preventative care and wellness support (including sexual and reproductive health). The role works collaboratively with an interdisciplinary team of clinical and non-clinical members to develop member care plans and to support members throughout their care journey. The Pod Provider also assists with the development and enhancement of clinical programs, initiatives, processes, and policies. Hybrid Role: On-site and Virtual-Must reside in the Detroit area Monday-Friday: 8am-5pm

Requirements

3+ experience

Responsibilities

Conduct comprehensive clinical intake visits.
Provide longitudinal direct primary care or wrap-around care with focus on chronic condition management and preventative care.
timely follow-up for members post transition of care event, acute need or according to condition-specific needs.
Proactively outreach to members who need follow up care.
Complete comprehensive and compliant diagnosis capture related to HCC (Hierarchical Condition Categories) and ICD-10 (International Classification of Diseases-10) Coding.
Address contractual and company-prioritized quality gaps and ensure proper chart documentation and codes (ICD or CPT) are included in the encounter as supporting evidence of gap closure.
Prescribe 1st and 2nd line medications for depression, anxiety, alcohol use disorders and opioid use disorders.
Remain up to date on evidence-based care for complex patients in primary care: (adult only, pediatric in certain markets).
Refer member to specialist care appropriately and according to internal CBH guidance if available.
Support the member in achieving the goals in their care plans (physical, behavioral, and/or social health).
Participate in case conferences with the care team, providing clinical expertise on care plan development.
Provide guidance on highest impact clinical interventions and tasks to achieve a member’s goals.
Collaborate on a panel of members to provide clinical input, including health maintenance, chronic disease management and co-occurring psychiatric disorder support.