JOB PURPOSE:
In collaboration and consultation with physicians, staff RN's and other health care professionals, provides holistic, compassionate care to patients and families and provides care coordination and care management activities on behalf of the PruittHealth Premier Plan. Practices within the context of collaborative management with the physician(s) in diagnosing, managing, and preventing acute and chronic illness and disease, and promoting wellness. Nurse Practitioners have an advanced nursing practice that includes independent nursing functions based on nursing standards of care and a role in medical management working within a collaborative agreement with a physician(s).
KEY RESPONSIBILITIES:
1.Proven ability to perform comprehensive, adult/geriatric physicalexam
2.Demonstrates ability to identify, diagnose and document chronic disease inadults
3.Demonstrates ability to recognize conditions, characteristics, and behaviors that place seniors atrisk
4.Proven ability to pursue feedback, continuing education and professionaldevelopment
5.Ability to effectively reconcilemedications
6.Demonstrates ability to identify and document the needs of clinically complexpatients
7.Work collaboratively with physicians, case managers, social workers, family members, key care givers and any appropriate ancillary medical personnel asappropriate
8.Participates in and/or directs Quality Assurance Performance Improvement (QAPI)activities
9.Understands the PruittHealth Premier Plan benefits, PruittHealth Premier Plan policies, procedures and articulate them effectively to providers, members and keydecision-makers
10.Assesses the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate teammembers
11.Coordinates care as member's transition through different levels of care and care settings, ensuresthat the ICP is communicated immediately and/or no later than 24 hours to the receiving care setting
12.Establishes schedule according to approved PHP nurse practitionerworkflow
13.Establishes and documents visit schedule according the HRA stratification (low, moderate,high)
14.Ensures all Members have an ICP developed within 48 hours ofHRAT
15.Facilitates agreement and implementation of the member's plan of care by engaging beneficiary, the facility staff, families/responsible parties, primary and specialty carephysicians
16.Evaluates the effectiveness, necessity and efficiency of the plan, making revisions asneeded
17.Utilizes practice guidelines and protocols established by PruittHealth PremierPlan
MINIMUM EDUCATION REQUIRED:
Graduate of an accredited Adult or Family Nurse Practitioner Master’s Degree program.
MINIMUM EXPERIENCE REQUIRED:
Minimum 2 years clinical experience as a Nurse Practitioner in geriatric, adult or family practice setting. Proven ability to perform comprehensive, adult/geriatric physical exam.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current and unrestricted, RN and NP licensure in state of practice. Board certification by AANP or ANCC, in Adult, Family Practice and Geriatrics or Adult-Gerontology Primary Care. Current CPR certification
ADDITIONAL QUALIFICATIONS: (Preferred qualifications)
Graduate of an accredited Geriatric, Adult or Family Nurse Practitioner Master’s Degree program. Previous long term care experience strongly preferred.
KNOWLEDGE, SKILLS, ABILITIES
1.Pertinent Clinical Work Experience which is relevant to population beingserved.
2.Reviews and interprets the medical and social history ofmembers
3.Interprets laboratory data, recommend appropriate follow-up, reconcilemedications
4.Manages both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialtyprovider
5.Synthesizes information and easily diagnoses and creates a comprehensive plan ofcare.
6.Ensures that individual plan of care is developed with specific interventions designed to meet the needs identified in the Health RiskAssessment
7.Performscomprehensiveassessmentsanddocumentfindingsinaconcise/comprehensivemannerthat is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
8.Performs Health Risk Assessment within seven (7) days of enrollment for a new beneficiary and annually within one year of the initialassessment.
9.Conducts an annual Comprehensive Geriatric Exam that incorporates CMS Annual a WellnessVisit
elements, including the Personalized Prevention Plan Services (PPPS)
10.EnsuresalldiagnosesareICD-10codedaccuratelyanddocumentedappropriatelytosupportthe diagnosis at thatvisit
11.ConductsHRAcomprehensiveface-to-faceassessmentifthememberexperiencesachangeincondition and/or transition in care—a “trigger”event.
12.Reviewsordersandinterventionsforappropriatenessandresponsetotreatmenttoidentifymosteffective plan of care that aligns with the member's needs andwishes
13.Evaluates plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessaryhospitalizations
14.May be required to participate in on-call program, after hour or coverage may berequired
15.Rotating on callresponsibilities
16.Travels between care sitesmandatory
17.Performs other duties asassigned
Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.
We are eager to connect with you! Apply Now to get started at PruittHealth!
As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.
