Nurse Practitioner – Telehealth Care Management

Nurse Practitioner – Telehealth Care Management (New Mexico Market)

Full-Time | Virtual | Texas-Based Candidates with New Mexico Licensure Bilingual Required (English/Spanish)

Overview

A rapidly growing value‑based healthcare organization is expanding into the New Mexico market and seeking bilingual Nurse Practitioners based in Texas to help launch and shape this new clinical program. This is a rare ground‑floor opportunity to influence how proactive, coordinated, home‑centered care is delivered to some of the most vulnerable and underserved patients in the healthcare system.

The populations served often include frail older adults, individuals with physical disabilities, and those with intellectual or developmental disabilities who rely on home and community‑based services. Early warning signs of declining health frequently go unnoticed until they become emergencies. This organization exists to catch those signs early, coordinate care proactively, and keep patients safely at home.

Rather than replacing a patient's primary care provider, this team acts as a proactive clinical extension—providing high‑touch support between office visits, coordinating across care teams, and intervening early to prevent avoidable hospitalizations and emergency department visits.

Spanish fluency is strongly preferred for this market given the linguistic and cultural needs of the New Mexico patient population.

Key Responsibilities

• Deliver comprehensive care management for medically complex Medicaid and Dual Eligible members through telehealth and remote monitoring
• Conduct patient assessments, medication management, care planning, and follow‑up using virtual care technologies
• Coordinate care with PCPs, specialists, managed care organizations, and community partners
• Lead and document advance care planning and goals‑of‑care conversations with patients and families
• Ensure accurate, compliant clinical documentation supporting HCC coding, risk adjustment, STAR ratings, and HEDIS gap closure
• Support hospital admission and discharge planning to ensure smooth transitions back to the home setting
• Contribute to the development and continuous improvement of clinical protocols, workflows, and best practices as the New Mexico program grows
• Build strong, trusting relationships with patients, families, caregivers, and interdisciplinary team members

Required Qualifications

• Active Nurse Practitioner license in New Mexico or ability to obtain one
• Board certification as Family Nurse Practitioner (FNP) or Adult‑Gerontology Nurse Practitioner (AGNP)
• Minimum 3–5 years of independent advanced practice experience
• Full prescriptive authority and active DEA registration
• Bilingual in English and Spanish (conversational fluency required; clinical fluency strongly preferred)
• Compact RN license preferred to support multi‑state expansion
• Comfortable practicing autonomously in a fully virtual care environment
• Must reside in Texas

Preferred Qualifications

• Experience managing medically complex Medicaid or Dual Eligible populations, including frail elderly, disabled individuals, or those with IDD
• Significant telehealth or virtual care delivery experience
• Working knowledge of value‑based care, HCC coding, risk adjustment, STAR ratings, and HEDIS measures
• Experience conducting advance care planning and goals‑of‑care discussions
• Experience with hospital‑to‑home transitions and discharge planning
• Existing Medicare/Medicaid provider numbers
• Prior health plan credentialing
• Entrepreneurial mindset and comfort working in a startup or build environment

The Ideal Candidate

You are a seasoned, board‑certified FNP or AGNP with deep experience managing chronic, complex adult and geriatric patients longitudinally—not just episodically. You understand how documentation drives both patient outcomes and organizational performance, and you treat HCC coding and quality gap closure as essential components of clinical excellence.

You are bilingual in English and Spanish and recognize how language access transforms care for patients navigating complex medical and social systems. You meet patients where they are—clinically, culturally, and emotionally.

You thrive in a telehealth environment and are energized by the opportunity to help launch a new market. You don't need a fully built playbook; you help write it.

You are based in Texas, hold or are pursuing New Mexico licensure, and ideally carry a compact RN license to support future multi‑state expansion.

Schedule

Full‑time, 40 hours per week, primarily during business hours. Candidates must be willing to participate in a shared 24/7 rotating clinical triage and after‑hours support model.

Employment Type

W‑2 and 1099 options available.