Nurse Practitioner, CoCM Bridge
Posted about 8 hours ago
RemoteMassachusetts115k - 155k USD
About the role:
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.
Direct Clinical Care
- 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
- Supporting 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
Indirect Clinical Care
Interdisciplinary Collaboration
Clinical Diagnosis and Documentation, Quality, and Compliance
Technical Fluency and Innovation
Required
- 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
- 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
Preferred
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Accompany Health
View company pageAccompany Health is on a mission to give patients with complex needs the dignified, high-quality care they deserve but rarely receive. A primary, behavioral, and social care provider, Accompany Health walks alongside patients for their entire care journey, offering at-home and virtual care, as well as 24/7 support. Partnering with innovative payors, Accompany Health is powered by remarkable care teams, elegant technology, and a commitment to evidence-based practice. We build long-term relationships with our patients so they know, without question, that our team is here for them day or night, year after year. We focus on the health outcomes most important to our patients to make it clear that they lead the way. To achieve our mission, we collaborate with community-based organizations, local providers, and health plans. While our headquarters is in Bethesda, MD, our teams are distributed across the country. If you’re eager to make a tangible difference in people’s lives, to help correct long-standing disparities in health care, join us. To learn more about career opportunities at Accompany Health check out our career page at www.accompanyhealth.com/careers.
Key team members
Mike Szott, J.D.
Andrey Nalitkin
Ming Yeung
Annie Beatty
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