Medical Matron
4 weeks ago
Monogram Health is looking for skilled Nurse Practitioners and Physician Assistants eager for the opportunity to make a difference in patients' lives. The Advanced Practitioner at Monogram Health is a key member of an integrated Care Team which includes a Registered Nurse and a Social Worker. Our Nurse Practitioners and Physician Assistants help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Using your skills in this position will allow you to deliver personalized compassionate medical care to individuals mainly with CKD and/or ESRD/ESKD. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don't positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.
Flexible scheduling with a hybrid and in-home mode
* Value-based care, patient-focused and allows you to spend time with those in your care
* Comprehensive medical, dental, vision and life insurance
* Paid vacation and holiday time
* Paid relocation assistance- location and case dependent
About Monogram Health
Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.
Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment
* Counsels and educates patients and families about benefits and programs available to help them live healthier lives
* Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan
* Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services
* Maintains quality of care standards as defined by the practice
* This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state
* Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first
* Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily
* Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing
* Assists patients with enrolling to access educational videos
* Participates in the integrated care team meetings
* Make assessment of patient's health status
* Implement a plan consistent with appropriate plan of care
* Bilingual (English/Spanish) highly preferred
* Ability to work without direct supervision and practice autonomously
* Access to transportation, a valid driver's license, and car insurance
* Must be proficient with medical instruments and equipment required by the work
* Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology
* Ability to communicate effectively in verbal and written form with retail and medical partners at various levels, patients, family members, physicians and representatives of the community
* 2 or more years of direct patient care required
* Managed Care/IPA/Health Plan experience
*
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