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Field Based Nurse Practitioner
4 months ago
Field Based Chronic Care Nurse Practitioner – Evernorth
We are a home based healthcare solution for patients and families facing chronic, complex and life-threatening illness. We are an innovative, multi-specialty practice experiencing tremendous growth nationwide. We offer patients and families a complete population health model, focusing our practice in caring for patients across the continuum of complex and serious illness.
Our focus is comprehensive care at home to improve quality of life, increase understanding and management of serious illness, facilitate coordination between providers, and decrease unnecessary healthcare cost. We are an interdisciplinary group of clinical professionals that understand the needs of patients, medical professionals, health systems and payers. We meet the patients where they are within the continuum of serious and complex illness; we provide the right level of care at the right point in time. This includes health risk assessments, transitions of care, complex and chronic disease management, and palliative care.
• Chronic Care Management: health plans look to us to conduct in-home longitudinal care for medically complex patients with chronic illnesses in an effort improve clinical outcomes. Our team collaborates with the patients' primary physician in the CCM program
• Palliative Care: health plans look to us to provide community based palliative care in the patient's homes. We provide physical, emotional and spiritual support for patients who are facing life-threatening illnesses, in order to provide relief from pain and other physical symptoms, psychosocial and spiritual care, and emotional support and improve quality of life.
We are currently seeking nurse practitioners who are passionate about serious illness care to join our growing house calls practice to provide both chronic disease management and palliative care as we further extend our operations serving a variety of Medicare Advantage, Medicaid, and Commercial clients.
Duties & Responsibilities:
• Perform home visits with patients enrolled in Chronic Program (CCP) and/or Chronic Care Management program (CCM). Initial visits are comprehensive evaluations with subsequent visits targeting chronic care management and risk factors for disease exacerbations and hospitalizations.
• Complete medical assessments, including reviewing medical history, conducting full physical and psychosocial assessments, evaluating and interpreting diagnostic and radiology tests
• Manage episodic and/or chronic medical problems, as well as preventive care and counseling
• Creating customized care plans to meet the needs of each individual patient, collaborate with the Interdisciplinary Care Team
• Identify gaps in care, risk factors and care coordination needs as well as assist in interventions to mitigate barriers
• Provide education to patients and/or patient's family on chronic medical conditions, preventative care, and medication adherence compliance
• Conduct Advanced Care Planning/End of Life/Palliative Care goals & discussions
• Coordinate with patient's other providers including specialists and health plan case managers to ensure all are working together with the patients towards the same goals.
• Participate in ICT rounds
• Working closely with members of our care team to ensure quality care is delivered in a timely manner. The care center will assist with scheduling and triaging of urgent issues.
• Sharing after hour telephone on-call coverage with other licensed providers on the team.
• Clinical documentation of acute and chronic healthcare issues, symptoms, and goals of care through patient encounter in EMR system. Documentation must be appropriate and thorough, and completed in a timely manner.
• Provider will ensure all appropriate consent forms are signed and dated
• Perform urgent care visits in the home and telephonically to avoid unnecessary ED transfers and hospital admissions
• Leverage the support of care team such as: nurse care manager, behavioral health, social work, and pharmacy to meet patients' medical, biopsychosocial, and financial needs
• Perform Telehealth visits at times when needed
• Complete appropriate and thorough clinical documentation of acute and chronic health issues through patient encounter in EMR system;
• Complete EMR documentation in a timely manner; Ensuring all appropriate consent forms are signed and dated; Interpreting laboratory data and diagnostic testing when available to assist in diagnosis of medical conditions
• Performing ADL and fall risk assessments; cognitive impairment, depression, and nutritional health screening; BMI measurement; medication reconciliation;
• Improving provider relations through direct communication, knowledge of appropriate evidence-based clinical information, and the fostering of positive collegial relationships;
• Performing other duties as assigned by the practice manager.
• Interpreting laboratory data and diagnostic testing when available to assist in diagnosis of medical conditions;
• Collaborating with the multidisciplinary team which may include: patients' PCPs and health plan case managers;
• Having the ability and the experience to prescribe medications, order labs or diagnostic testing, and recommend sub-subspecialty referrals and collaborating with the community PCP if appropriate.
Knowledge, Skills, Abilities and Requirements:
• Graduated from an Advanced Nurse Practitioner program in Adult, Geriatric, or Family Nurse Practitioner.
• Prior clinical experience in geriatrics is preferred.
• Prior home based care experience is preferred
• Experience with electronic medical records is required. Also required is proficiency with various computer based applications such as Microsoft Office.
• Strong background/interest in primary care and preventative medicine and Comfortable treating with a palliative care approach when indicated
• Must have valid state driver's license
• Highly motivated, self-directed professional with strong organizational skills and comfortable working independently on a daily basis
• Excellent clinical assessment and analytical skills
• Effective leadership and interpersonal skills; facilitates problem resolution and maintains a professional demeanor in difficult situations.
• Excellent verbal and written communication skills
Certifications:
• NP candidates must be board certified by the ANCC or AANP, and have current RN and NP licensure in state of practice
• Specialty certification in Hospice and Palliative care desired (CHPN or ACHPN)
• Must have current BLS certification; ACLS preferred.
• Must have active/unrestricted license in state of position opening
• New graduates will be considered
• Must be able to be credentialed by Medicare, Medicaid, and other Private Insurance Companies
• Possession of DEA registration or ability to obtain is required
Work Environment:
• Assessments done primarily in patient's home;
• Documentation typically completed at provider's home or at the end of workday;
• Typical hours are from 8 am to 5 pm with some flexibility;
• Telephonic after hour on-call duties required, shared with team;
• Great Work / Life Balance / Autonomy;
• Flexible scheduling to see patients according to provider's preference so long as productivity ensured and if full-time a minimum of 8 hours per day;
• Schedulers will make every effort to have home visits located near the physician's home residence when possible;
• Fleet car may be provided if mileage usage requirements are met per policy and approved by leadership.
• Provider will participate in on-call program. On call consists of after-hours & weekend telephonic coverage one week at a time in a rotating pattern. On call provider will assist with coverage of team assignments when team is on PTO or PRN.
Benefits/Rewards:
• We offer an excellent compensation, along with comprehensive malpractice insurance with tail coverage and full corporate benefits package, including 401K for regular employees;
• All providers receive smartphone and laptop computer, along with a medical bag containing all necessary equipment/supplies to conduct in-home patient visits;
• If you're seeking a role with a great work / life balance, and want to work with a friendly, supportive and professional team, THIS ROLE IS FOR YOU
• CME allowance: 5 days and $2500 per year for Full-time employees;
• Generous PTO, holiday pay;
• Education reimbursement program for permanent employees;
• Training, orientation and supplies provided;
These are field-based openings in greater Chicago IL (Cook, DuPage & Kankakee Counties) and Provider must live locally to the territory.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
