Nurse Practitioner
17 hours ago
We are a premier home-based healthcare solution for patients and families facing chronic, complex and life-threatening illness. Our innovative, multi-specialty practice is experiencing tremendous growth nationwide, offering patients and families a complete population health model, focusing on caring for patients across the continuum of complex and serious illness.
Our comprehensive care at home aims 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, providing 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 support.
We conduct in-home longitudinal care for medically complex patients with chronic illnesses, aiming to improve clinical outcomes and decrease utilization. We provide physical, emotional, and spiritual support for patients facing life-threatening illnesses.
We are currently seeking nurse practitioners who are passionate about serious illness care and management to join our growing house calls practice, providing both chronic disease management and palliative care support, 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 care risk program, conducting comprehensive evaluations and targeting risk factors for disease exacerbations.
- Closely work with other team members to ensure quality care is delivered, coordinating with patient's other providers, including PCP, specialists and health plan case managers.
- Share after hour on-call coverage with other providers on the team, working with field and office RN and medical assistants.
- Clinical documentation of acute and chronic healthcare issues through patient encounter in EMR system, ensuring all appropriate consent forms are signed and dated.
- Provide education to patients and/or patient's family on chronic medical conditions, preventative care, and medication adherence compliance.
- Participate in weekly telephonic clinical meetings and occasional web-based compliance trainings, prescribing medications, ordering labs or diagnostic testing, and making sub-subspecialty referrals.
- Collaborate with the supervising physician and other members of healthcare team to ensure outstanding patient care is delivered, interpreting laboratory data and diagnostic testing when available to assist in diagnosis of medical conditions.
- Screen for ADL/IADL deficits, fall risk, depression, cognitive impairment and nutritional health as part of initial and annual assessments, performing medication reconciliation at every visit.
- Graduated from an Advanced Nurse Practitioner program in Adult, Geriatric, or Family Nurse Practitioner.
- Active, unrestricted NP license in respective state, board certified by the ANCC or AANP or geriatrics, and current RN and NP licensure in state of practice.
- Current BLS certification, ACLS preferred, DEA license and State Controlled Substance License upon hire or within 6 months of hire.
- Experience with electronic medical records is required, proficiency with various computer-based applications such as Microsoft Office.
- Prior clinical experience in geriatric, adult or family medicine is preferred, strong background/interest in primary care and preventative medicine.
- 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, facilitating problem resolution and maintaining a professional demeanor in difficult situations.
- Demonstrated ability to identify, diagnose, treat and document acute and chronic disease in adults, demonstrated ability to recognize conditions, characteristics, and behaviors that place patients at risk.
- Ability to pursue feedback, continuing education and professional development, proof of yearly influenza vaccination, Hepatitis B vaccination, and TB testing required.
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