Job Details
Job Summary
The Care Connections NPs focus on screening and preventive primary care services delivered in the home, community and nursing facility settings. Provides needed care in the environment that patients feel most comfortable and are most receptive including home, nursing facilities, and pop up clinic.
The Nurse Practitioner will be required to work primarily in non-clinical settings and provide medical care to all levels of patients. Some programs may focus on specific populations (e.g., adult and geriatric, pediatric, women's health).
Perform comprehensive medical assessments, order appropriate tests/procedures for diagnostic purposes, formulate treatment plans, obtain specialists' consultations as needed, and do appropriate documentations as required. Job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function allowed by state law.
Knowledge/Skills/Abilities
Duties and Responsibilities (List all essential duties and responsibilities in order of importance)
Provide general medical care to various and/or specific patient levels adults, geriatrics and pediatrics.
Perform comprehensive evaluations including history and physical exams for risk adjustment and other regulatory assessments
Address both chronic and acute primary care complaints, and able to ascertain medical urgency
Establish and document reasonable medical diagnoses
Seek specialty consultation as appropriate
Order pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptom; able to work within an environment of limited resources and therefore uses diagnostic tests judiciously and appropriately
Discuss unusual or unclear symptoms or results with consulting physician in a timely manner
Accept feedback and direction from the supervising physician
Create and implements a medical plan of care
Provides care coordination and preventative care services for geographical as well as virtual targets who are stratified by risk.
Schedule patient appointments for telehealth or in-person visits when appropriate
Provide post discharge coordination to reduce hospital readmission rates and emergency room utilization
Perform face-to-face in-person visits in a variety of settings including home, skilled nursing facilities, and public locations.
Additionally, perform face-to-face synchronous video communications using Tele-Health platform based on business need and leadership direction
Order bulk laboratory orders to target specific populations of member.
Perform alternating on-call coverage to triage any urgent lab results and develop appropriate plan of care
Participate in community-based Pop Up Clinics as way of building relationship with community while addressing gaps in health care
Collaborate with fellow nurse practitioners to develop best practices to efficiently and effectively carry out work duties
Actively participate in regional meetings
Prescribe medications as appropriate
Remain knowledgeable on current therapies
Perform timely documentation in medical records in an electronic medical record computer system
Engage in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. May also function as and perform all duties reasonably expected and assigned to an RN such medication administration.
Work as a partner with supervising physician. The NP is responsible for initiating collaboration, as it is needed.
The NP is responsible for knowing when a patient needs physician oversight and when the patient's medical condition may be beyond the scope of knowledge of the NP.
Job Qualifications
Required Education
Master's degree in family health from accredited nursing program