Nurse Practitioner, CoCM Bridge

Accompany Health•Detroit, MA

1d•$115,000 - $155,000•Remote

About The Position

As an Accompany Health Advanced Practice Clinician, CoCM/Bridge psychiatry you will serve patients with mild to moderate mental health, SMI and/or substance use needs, grounded in the evidence-based Collaborative Care Model that has also been adapted to meet patients with SMI/SUD (Bridge). You will be primarily seeing patients in our Bridge Care program, which will involve direct patient care conducted via video, phone and/or text in order to improve BH condition management, treatment-to-target, and reduction in avoidable inpatient / ED utilization. You will be responsible for accurate and appropriate clinical diagnosis of BH conditions, treatment initiation and titration including medications, and coordination of care for patients with severe mental illness (SMI), including substance use disorders. You will be supported by a supervising med-psychiatric physician as well as behavioral health clinicians (LCSW/LPC). Within our Collaborative Care Program, you will serve as the primary psychiatric consultant with the support of a supervising med-psychiatric physician in this model, supported by med-psychiatric advanced practice clinicians and behavioral health clinicians. In collaboration with primary care and advanced practice clinicians, you’ll deliver patient-centered, measurement-based, treatment-to-target care. In addition, you will perform e-consults for our primary care teams to provide recommendations for BH diagnostic clarity and medication management. This role is ideal for an APC who embraces innovation, values autonomy, and wants to help shape clinical models that merge technology, compassion, and evidence-based practice.

Requirements

Active Nurse Practitioner (NP) or Physician Assistant (PA) license in the state of employment and willingness to obtain additional licensure as requested
Certification by the American Nurses Credentialing Center (ANCC) in Psychiatric Mental Health (PMH) as a Psychiatric Mental Health Nurse Practitioner (PMHNP) or Physician Assistant with Psychiatry CAQ
Active DEA registration or eligibility to obtain; X-waiver preferred but not required
Active or eligible state-controlled substance license
Current Basic Life Support (BLS) certification
Demonstrated strong clinical judgment and ability to make independent medical decisions
Proficiency in using electronic medical record (EMR) systems
2+ years of experience in assessing, provisional diagnosis, planning, and managing behavioral patient care as acquired through clinical experience
5+ years of experience working in high risk populations with serious mental illness and substance use disorder
Expertise with DSM5 diagnostic criteria
Highly skilled in trauma-informed care and culturally sensitive care
Experience and comfort working within an interdisciplinary care team, and specifically closely collaborating with community health workers and primary care providers

Nice To Haves

Experience working with patients with substance use disorders including prescribing suboxone, naltrexone, acamprosate, and benzodiazepines for detoxification
Experience working in value-based care setting and/or managed care, including how to appropriately assess STARS/HEDIS measures, accurately and appropriately diagnose and code clinical comorbidities, and identify clinical care gaps

Responsibilities

Conduct virtual comprehensive psychiatric evaluations, including diagnostic assessments, medication management, and treatment planning
Prescribe medications for depression, anxiety, PTSD, bipolar disorder, schizophrenia, substance use disorders, and other DSM5 diagnoses (this includes prescribing controlled substances in accordance with a Collaborative Practice Agreement)
Manage patients with substance use disorders in collaboration with behavioral health clinicians, including initiating or continuing medications for opioid use disorder and alcohol use disorder when appropriate
Utilize measurement-based tools (e.g., PHQ-9, GAD-7, PCL-5) to track patient progress and adjust treatment plans
Order and follow-up appropriate laboratory testing and other monitoring for patients
Provide consultative guidance to primary care and behavioral health team members on psychiatric management within the CoCM model
Manage a defined behavioral health caseload within the Collaborative Care and Bridge programs, ensuring timely follow-up and measurement-based care
Support urgent behavioral health needs by performing timely risk assessments, safety planning, and coordinating crisis intervention when required
Support patients in transitions of care from facilities for admissions related to behavioral health diagnoses, including but not limited to: coordinating on discharge plans with inpatient care management, performing assessments to identify risk factors for readmissions, ensuring close follow-up and coordinating services
Transition of patients from our Advanced Behavioral Health Program to CoCM or Bridge
Performs other duties as assigned
Participate in weekly Behavioral Health Case Conferences (BHCC) with BHCs, including monitoring new patients, treatment planning for patients who are not improving, diagnosis refinement, management of safety issues, and patients leaving our programs
Communication with APCs on clinical recommendations made in BHCC
Communication with PCPs on clinical recommendations made in BHCC
Recognition of when to escalate supervision of complicated patients to Med-Psychiatry Associate Medical Director
Collaborate with Psychiatrists, Behavioral Health Clinicians, Med-Psych APCs, Primary Care APCs and Physicians, Care Team Managers, Community Health Workers, Patient Experience Navigators, and other team members to coordinate patient care
Collaborate with guardians, relatives, and significant others on client’s conditions and treatment when clinically appropriate
Ensure accurate and appropriate diagnosis, coding and documentation of chronic conditions with evidence-based treatment plans
Maintain timely, accurate documentation in EMR and custom care platforms and timely response to clinical queries
Provide integrated care for patients with both physical and behavioral health needs, including assisting with appropriate chronic condition diagnosis, preventative gap closure, and connection to primary teams
Utilize digital tools and telehealth platforms to enhance patient engagement and care delivery
Contribute to the development and refinement of clinical protocols, digital workflows, and care models
Participate in quality improvement initiatives and help design innovative care programs as the organization scales