• IRNJ Clinician Application

  • Screening

  • To determine program eligibility, please indicate your work authorization status:*
  • In your role, do you provide direct patient care at least 30 hours per week?*

  • At the end of the application, upload work schedule for verification.

    Direct patient care is defined as in-person, face-to-face contact with patients for the purpose of diagnosis, treatment, and monitoring.

     

  • Before Starting Application

  • Invest Rural NJ is a workforce investment initiative designed to recruit new clinicians into rural practice and retain the existing rural health workforce through five-year service commitments supported by annual, non-salary incentives. By prioritizing high-scarcity disciplines and clinicians new to rural care, the program reduces vacancies and turnover while improving access to primary, dental, and behavioral health services in high-need rural communities across New Jersey.

    Before starting your application, please have the following materials available. This will be required to be uploaded at the end of the application:

    • Copy of identification (driver’s license, passport, Green Card, etc.)
    • Copy of work schedule or proposed work schedule
    • Copy of license or license application submission
    • Signed offer letter (new to rural NJ applicant only)
    • Most recent paystub (current rural NJ applicants only)
    • Proof of address change (for relocation support request only)
      • Acceptable forms of proof: 
        • Lease agreement or mortgage statement
        • Utility bill
    • Copy of sliding fee scale, Charity Care policy, and/or Manage Care Organization (MCO) participation agreement
      Support services are offered at reduced costs based on a patient's income and ability to pay.
    • Proof of hybrid/shared staffing model between health systems and FQHCs, if applicable
      • Acceptable forms of proof:
        • Executed MOU or agreement
        • Contract or affiliate agreement between entities
        • Shared staffing agreement outlining clinician deployment
        • Joint employment or subcontracting agreement
  • Image field 121

  • Create your unique participant identifier (UPI)

  • Please create a unique identifier for your application. We are asking for you to create a UPI to connect clinician and employer companion applications together. Your UPI should contain the following:
    • IRN in the beginning
    • First character and third character of first name
    • First character and third character of last name
    • Date of birth (MMDDYY)

    Example:
    First name: John
    Last name: Smith
    Date of birth: 04/03/2020
    UPI: IRNJhSi040320

  • SECTION 1. Applicant Information

  • At the end, upload copy of ID, Passport or Green Card for verification.

  • Employment Status:

  • Applicant Type*
  • New Applicant-Anticipated start date at rural site*
     - -

  • At the end, upload signed offer letter

  • Retention Applicant- Commencement date current at rural site*
     - -

  • At the end, upload proof of current employment (most recent paystub).

  • SECTION 2. Professional Information

  • SECTION 3. Rural Practice Site Information

  • All organization types must meet Federal or State definitions of rurality. All organizational entities must serve Medicaid, Medicare, uninsured populations, underinsured populations, have a sliding fee scale, Charity Care policy and/or Managed Care Organization (MCO) participation agreement.

  • SECTION 4. Rural Workforce Status

    Which best describes you? (Select one)
  • New applicants to rural NJ health care:*
  • For applicants currently practicing in rural health care in NJ*

  • SECTION 5. Recruitment and Relocation

  • Are you relocating for this position?*
  • Desired Relocation Counties/ Municipalities

  • SECTION 6. Commitment & Retention Narrative

  • In 250 words or fewer, please describe:

    • Why you are interested in rural practice
    • Any personal, professional, or community ties to rural and underserved areas
    • Factors that support your ability to commit to long-term rural service
  • 0/250

  • SECTION 7. Site Need & Access Impact

  • In 250 words or fewer, describe how your role addresses access gaps at the rural site, such as:

    • Reducing high vacancy/ hard-to-fill role; long wait times; limited speciality access
    • Expanding services (primary care, dental, behavioral health, OB, etc.)
    • Serving high-need populations (Medicaid, Medicare, uninsured and underinsured populations)
  • 0/250

  • SECTION 8. Equity & Priority Populations

  • Will your clinical practice primarily serve any of the following? (Check all that apply)*

  • At the end, upload copy sliding fee scale, Charity Care policy, and/or Managed Care Organization (MCO) participation agreement.

  • 0/150

  • SECTION 9. Geographic Priority

  • Is the proposed site location(s) in any of the following? (Check all that apply)*
  • What additional geographic priority designations apply? (Check all that apply)

  • Links listed below to help identify site location:

    • Social Vulnerability Map
    • Federal Rural Health Eligibility (RCT)
    • Health Professional Shortage Area
    • HRSA MUA/P Find

  • Use the “Am I Rural?” tool (https://www.ruralhealthinfo.org/am-i-rural#/) to verify eligibility. Enter the rural work address, run the report, confirm rural eligibility (scroll down - under program eligibility), and provide the 11-digit rural census tract listed under “Location” (scroll back up - at the top).

  • SECTION 10. Practice Readiness

    If new to rural health care in NJ, please answer below.
  • Estimated time to begin patient care at rural site*

  • SECTION 11. FQHC Participation

  • If not already, are you willing to work part time at an FQHC within an RCT?*
  • 0/150

  • SECTION 12. Attestations & Acknowledgements

  • By signing below, I attest that:*

  • File Upload

  • To complete your application, please upload the following materials available.

    • Copy of identification (driver’s license, passport, Green Card etc.)
    • Copy of work schedule or proposed work schedule
    • Copy of license or license application submission
    • Signed offer letter (new to rural NJ applicant only)
    • Most recent paystub (current rural NJ applicants only)
    • Proof of address change (for relocation support request only)
      • Acceptable forms of proof: 
        • Lease agreement or mortgage statement
        • Utility bill
    • Copy of sliding fee scale, Charity Care policy, and/or Manage Care Organization (MCO) participation agreement
      Support services are offered at reduced costs based on a patient's income and ability to pay.
    • Proof of hybrid/shared staffing model between health systems and FQHCs, if applicable
      • Acceptable forms of proof:
        • Executed MOU or agreement
        • Contract or affiliate agreement between entities
        • Shared staffing agreement outlining clinician deployment
        • Joint employment or subcontracting agreement
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    • Thank you for your interest

      Based off your responses, you do not meet the eligible criteria for Invest Rural New Jersey. Thank you for you time.

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