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Nurse Practitioner – Chronic Care

Location: Pennsylvania-Philadelphia
Duration: Permanent - Full Time
Job ID: 20874810
Category: Nurse Practitioner - Home Health
Job Posted: 01/02/19

Duties and Responsibilities:

  • Focuses on the management and improvement of health for patients with multiple chronic medical conditions. Manage a panel of approximately 200 to 250 chronic care ambulatory patients in an office based setting. Work with 2 to 3 case managers and one medical assistant on the same team, supporting the care of these patients. Patients are all adult with an occasional adolescent.
  • Able to work in a team environment (with social work, case management, behavioral health, pharmacy, nutrition, etc.), process feedback, and be open to discussing and implementing plans of care from other members of the team. Work well with a supervising physician.
  • Develop strong transitional care plans and able to help keep track of paneled patients along the whole continuum of care including discharges from the hospital, ER, skilled nursing facilities/nursing homes, and home care
  • Communicate and interact with alternate levels of care facilities (hospital, ER, skilled nursing facilities) in order to facilitate appropriate discharge to a lower level of care or back to the AbsoluteCARE Medical Center. Familiar with inpatient medicine and the discharge process in order to help facilitate discharges.
  • Treatment of some acute exacerbations of chronic conditions within the AbsoluteCARE center, i.e. Lasix for CHF, IVF for Dehydration/Renal Failure, IV antibiotics for various infections, Nebulizer/Solumedrol for COPD/Asthma etc.. Possess a comfort level and the knowledge to differentiate when exacerbation can be treated within AbsoluteCARE and when a higher level of care needed. These treatments will involve collaboration and oversight with a supervising physician.
  • Accepts same day/next day or urgent appointments for patients from home or discharged from the hospital/ER/skilled nursing facility in need of intensified practitioner or case management/social work services to ensure acute episode has resolved and the patient is not admitted/readmitted.
  • Vigilant in keeping track of patients and their disease processes in order to prevent ER visits, admissions to the hospital, and readmissions.
  • Understands the PCMH model of care as pertains to specialist care, only utilizes this higher level of care as needed, and not a substitute for primary care using evidence based clinical skills
  • Assists with educating patients regarding their chronic diseases and healthy choices.
  • Assists with the education and discussion of chronic disease progression and the need for advanced directives.
  • Practices evidenced based medicine and in accordance with the PCMH model of care.
  • Able to keep track of and successfully obtain specified quality metric goals.
  • Uses technology and the electronic medical record to the highest capability in order to increase quality initiatives and efficiency within the medical center.
  • Participates in multi-disciplinary meetings and recommends treatment alternatives designed to keep patients healthy or resolve on-going clinical issues.
  • Perform other duties as required consistent with chronic care and disease management services provided to patients.
  • 40 hour work week
  • Report to the Medical Director

Qualifications:

  • Licensed Nurse Practitioner in the state of Pennsylvania. Experience with patients who have multiple chronic medical conditions, i.e. CHF, COPD/Asthma, HTN, Diabetes, Chronic Renal Failure…
  • ACLS certification
  • Long-term interest in AbsoluteCARE Medical Center
  • Detailed knowledge of chronic disease management programs and services.
  • Excellent organization and communication skills are necessary.
  • Great customer service skills
  • Works well with a supervising physician.
  • Knowledge of managed care and insurance processes is preferred.
  • Comfortable with and the ability to treat the acutely ill in an outpatient setting offering IV hydration, IV antibiotics, wound care and other services with the collaboration of a supervising physician.
  • Experience with the management of Medicare, Medicaid, and commercial populations.
  • Experience with using EMR and efficiency a must in completing EMR notes within 48 hours

Contact information

Company: Jordan Search Consultants
Address: ATTN: Kathryn Byrne
RE: PAJobSite.com Job 20874810
113 Church Street
O'Fallon MO 63366
Call: (636) 294-6082
Fax: (636) 294-6083

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