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Landmark Health was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to chronically ill patients, many of whom are frail, elderly and ill-equipped to navigate our overwhelming healthcare system.
Because many of our patients are frail and elderly, we deliver care primarily in the comfort of their home. Our Program is also offered to eligible patients at no incremental financial cost to them. We are not a fee-for-service practice; we benefit economically only if we deliver high-quality patient outcomes and satisfaction. As a result, our clinical teams can spend quality-time caring for a smaller number of patients, giving all patients the space, respect, compassion and care they deserve.
Our model is finding success throughout the country; we are now the nation’s largest risk-based, in-home medical group, with operations in numerous markets and states across the country.
At Landmark, our interdisciplinary teams collaboratively manage our complex patient panels. These teams are led by Physicians, Nurse Practitioners, and Physician Assistants, with supporting care provided by RN Nurse Care Managers, Social Workers, Pharmacists, Behavioral Health and other employed team members.
This position provides in-home psychiatric care and management to home based Landmark members with documented or suspected behavioral health conditions. Landmark recognizes that behavioral health can dramatically impact medical health. This position collaborates with the Chief Behavioral Health Officer, Associate Director(s) of Behavioral Health, Regional Medical Director(s), community PCP/Psychiatrist, interdisciplinary team and other health professionals to develop comprehensive goals of care. The integration of medical and behavioral health care is necessary to achieve optimal outcomes and quality of life for Landmark members.
- Provides psychiatric assessment, evaluation, diagnosis and treatment recommendations
- Provides collaborative consultation to staff and other providers on the interdisciplinary team in the management and treatment of patients with behavioral health conditions impacting their overall health and wellbeing
- Works in collaboration with the interdisciplinary team to ensure high quality care
- Provides support and education training to the interdisciplinary team in providing care for complex patients
- Focuses primarily on the Landmark population with mental health conditions utilizing psychiatric expertise to the inform the medical management plan and mitigate any negative impact that behavioral conditions can have on patient overall health and well-being
- Actively contributes during the weekly Landmark interdisciplinary team (IDT) meetings to ensure that behavioral health issues are considered and addressed for all high-risk patients
- Establishes and maintains effective relationships with members on their active panel and their legal representatives, facility staff, PCPs, existing psychiatrists and other collaborating mental health providers to maximize continuity and compliance with individualized member care plan
- Escalates and communicates any issues with Severely Mentally Ill (SMI), complex mental health patients, and any active inpatient psychiatric admission with the Chief Behavioral Health Officer, Associate Director(s) for Behavioral Health, or local designee
- Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nurses or physician assistants
- Understands and complies with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communities
- Calls and communicates directly with patient’s PCP and/or community Psychiatrists, in real time to review and discuss any change of condition and recommended medication changes. Plans will be collaboratively decided on with PCP/Psychiatrists, but if unable to reach them, in an emergent situation, the BH provider will render appropriate services and communicate changes at the first available opportunity
- Completion of RN accredited program or comparable program
- Completion of accredited program in Psychiatric/Mental Health Nurse Practitioner (PMHNP)
- Minimum of two (2) years clinical experience, with home-based care experience desired
- Knowledge of CPT, ICD-9/10 and HCPC codes
- Knowledge of clinical standards of care
- Familiarity with the use of telehealth desired
- Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems are helpful
- Access to reliable transportation to conduct patient visits required; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy.
- Must be board certified at the time of hire or able to obtain board certification within 2 years of hire
In order to work with potentially vulnerable patient populations and to keep employees healthy while caring for patients, all patient-facing employees of Landmark must provide evidence of the following required immunizations/vaccinations as a condition of employment: TB, MMR, Tdap, and Influenza. Declinations may be accommodated based on your medical history, an allergy or religious beliefs. Please immediately contact HR if you wish to apply for an exemption from our vaccination requirements so that we may determine if you qualify for an accommodation.