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Reports to the Chief Executive Officer and Chief Medical Officer

Background: Cahaba Medical Care Foundation is a community health center organization providing medical, pharmacy, dental, and behavioral health services to diverse underserved communities in Jefferson, Bibb, Perry, and Chilton counties. We are a Level 3 Patient-Centered Medical Home and Joint Commission accredited organization, committed to increasing integration and coordination of behavioral health and primary care. This is an exciting, fast paced practice with a strong mission and commitment to providing high quality care.

Position Summary

This position requires a mission-driven and detail-oriented Advanced Practice Provider (APP) to serve as our lead clinician for Medicare Annual Wellness Visits (AWVs), preventive care services, and related quality initiatives. This is a high-impact position designed to help our organization improve preventive care rates and quality outcomes across all 28 Cahaba Medical Care clinics.

The ideal candidate will have a passion for health promotion, quality improvement, and rural health equity. This provider will perform in-person wellness visits across our locations, follow up on necessary documentation (including insurer-specific requirements), and support training for other staff and providers in performing high-quality, compliant AWVs. This position reports directly to the Chief Executive Officer (CEO), Chief Medical Officer (CMO), and works in close coordination with the Quality Improvement Officer.

Cahaba Medical Care expects all of our licensed providers to host learners from time to time, since we are a teaching institution. This is our pipeline for recruiting excellent providers who want to serve the populations we take care of. Every student we accept applies for the chance to be here through a competitive process and is reviewed and assessed for their likelihood of working in an underserved, underresourced area in the future. We want to ensure they fit our mission. We try to give our newer providers time to get settled before adding them to our pool of available preceptors, and we offer best practices for integrating learners into your clinic without compromising efficiency.

Responsibilities & Duties

• Perform in-person Medicare Annual Wellness Visits and other preventive care visits across Cahaba Medical Care sites.
• Ensure all required elements of AWVs are accurately completed, documented, and submitted per payer and CMS guidelines.
• Submit insurer-specific forms and documentation in payer portals (e.g., closing care gaps, diagnosis attestation, HCC coding updates, etc.) to ensure loop closure.
• Collaborate with the Quality Team to ensure visits meet internal quality standards without additional remediation.
• Serve as a clinical resource and subject matter expert for AWVs, helping to train Medical Assistants, front-desk staff, and fellow providers on workflow best practices.
• Identify system barriers to completion of AWVs and work collaboratively to improve clinic workflows and efficiency.
• Support Cahaba Medical Care's system-wide goal of achieving a defined percentage of Medicare AWV completion prior to the calendar year's end (goal to be determined annually).
• Provide occasional care for acute, walk-in visits if clinically appropriate and needed on-site.
• Participate in organizational quality and training initiatives, special projects, and data-driven improvement work related to population health.

Required Skills/Abilities:

• Excellent communication and interpersonal skills.
• Strong clinical judgment and problem-solving abilities.
• Cultural competency and sensitivity to the needs of diverse populations.
• Ability to work independently and within a multidisciplinary team.
• Excellent attention to detail and ability to balance competing priorities.

Preferred Skills/Abilities

• Experience with value-based care, quality metrics (e.g., HEDIS, STAR ratings), and population health initiatives.
• Familiarity with payer-specific documentation or HCC coding workflows.
• Training or teaching experience (e.g., MA or provider education) strongly valued.
• Spanish language proficiency is a plus but not required.

Qualifications:

• Certified Nurse Practitioner or Physician Assistant with active Alabama license.
• At least 2 years of experience preferred, particularly in outpatient primary care, geriatrics, or quality improvement.
• Strong understanding of Medicare Annual Wellness Visit components and CMS documentation requirements.
• Exceptional attention to detail and follow-through.
• Willingness and ability to travel to multiple clinic locations across Central Alabama (reliable transportation required).
• Demonstrated commitment to underserved populations and mission-driven care.
• Comfortable working independently while coordinating with a multidisciplinary team.

Location

• Six-County Region (including Bibb, Perry, Chilton, Jefferson, Dallas, and Wilcox Counties)
• Travel is required with mileage reimbursement. This position involves driving to multiple Cahaba Medical Care sites across Central Alabama.