APRN – Medical Management (Value-Based Care)

Position Summary

The APRN – Medical Management role is a hybrid clinical leadership and care coordination position designed to reduce hospital admissions, readmissions, and avoidable SNF utilization through proactive medical management, care transitions, and interdisciplinary collaboration. This APRN will work closely with PCPs, Medical Directors, case management, and external facilities to ensure high-risk patients receive timely, coordinated, and appropriate care across settings.

Key Responsibilities

Clinical & Medical Management

- Provide advanced clinical oversight for high-risk and complex patients in a value-based primary care model - Perform medical management for patients with frequent hospitalizations, chronic disease burden, or care gaps - Support PCPs with care planning, post-discharge follow-up, and escalation of care needs - Assist with direct hospital admissions, SNF placement, and discharge planning when clinically appropriate - Monitor and manage length of stay (LOS) for hospital and nursing home patients

Utilization & Care Coordination

- Track daily hospital and nursing home admissions, discharges, and transfers - Coordinate transitions of care to reduce readmissions and adverse outcomes - Obtain weekly updates on nursing home patients and communicate changes to internal teams - Identify potential catastrophic, stop-loss, or high-cost cases - Support subrogation and cost-allocation identification as needed

Interdisciplinary Collaboration

- Lead or participate in interdisciplinary case conferences and care reviews - Communicate with patients, families, hospitals, SNFs, and community resources - Advocate for medically necessary services, diagnostics, and follow-up care - Coordinate transportation, community services, and ancillary resources

Quality, Process & Performance Improvement

- Evaluate workflows, utilization patterns, and care processes to improve outcomes - Support quality initiatives tied to Medicare Advantage, Medicare, and Medicaid metrics - Contribute to policy, procedure, and workflow redesign - Provide education and guidance to clinical staff to improve care coordination competency

Documentation & Compliance

- Maintain accurate, timely clinical and utilization documentation in the EMR (eCW preferred) - Ensure compliance with value-based care requirements, payer guidelines, and regulatory standards - Apply knowledge of CPT, ICD-10, and utilization review principles

Qualifications

Required

- Active, unrestricted Florida APRN license - DEA license or eligible to obtain within 60 days of hire - 2–3+ years of experience in primary care, geriatrics, or internal medicine - Experience in value-based care, Medicare Advantage, Medicare, and/or Medicaid populations - Strong knowledge of chronic disease management, preventative care, and quality metrics - Excellent communication, organization, and problem-solving skills

PREFERRED

- Background in case management, utilization management, or care coordination - Familiarity with InterQual or Milliman Care Guidelines - Prior RN case management or clinical coordination experience - Bilingual (Spanish/English)

What We Offer

- Competitive compensation with performance incentives - 401(k) with employer contribution - Medical, dental, vision, disability, life, and malpractice insurance - Generous PTO, CME time, and paid company holidays - Monday–Friday day schedule with no weekends or on-call - Career development and leadership growth opportunities

Palm Medical Centers is an Equal Opportunity Employer committed to diversity and inclusion.

Hiring decisions are based on qualifications, merit, and business needs.