Nurse Practitioner

BASIC PURPOSE & SCOPE:

Under the direction of the Program Director,and in collaboration with the Medical Director, the Nurse Practitioner is responsible for, but not limited to providing direct primary care, supervision, oversight, and day-to-day management of clinical support services and participant care coordination for Total Senior Care, Inc., as an established Program of the All-inclusive Care for the Elderly (PACE) and licensed managed long term care plan in NY State.

RESPONSIBILITIES:

1. Practices within his/her scope as defined by the regulations of New York.

2. Practices in collaboration with physician(s) in accordance with a written practice agreement

3. Performs primary care initial assessment, scheduled reassessments and episodic assessments in accordance with program requirements

4. Educates participants and/or caregivers about preventative care, advanced directives, medical issues, and use of prescribed treatments and medications.

5. Provides appropriate staff supervision and development for program and clinic staff,ensuring that supportive medical record documentation is accurate and timely for care management and utilization review.

6. Oversees clinical care coordination between the Interdisciplinary Team (IDT) and network providers to ensure services remain case-managed by the program across all care settings.

7. Coordinates with Quality Improvement Department to ensure QAPI plan activities relevant to participant care is conducted and ensures all necessary documentation and follow up occur within the time-frames defined by the program/operational policy/procedure.

8. Ensures coordination of subject to call schedule to ensure 24 hour access to care.

9. Enables the facilitation of the IDT process and care plan development, inclusive of practice and consistent protocol development for all services.

10. Regularly informs the IDT of the medical, functional, and psychosocial condition of each participant, remaining alert to pertinent input from team members, participants and caregivers with regard to any changing status or care needs

11. Provides evaluation and treatment of participant’s chronic and acute illness with the primary objective to optimize health outcomes and prevent hospitalization or institutional placement.

12. Discusses care guidelines and conducts patient education as necessary with participants,caregivers and identified Health Care Proxy

13. Discusses advanced directives and facilitates Medical Orders for Life Sustaining Treatment (MOLST) completion with participants and the Health Care Proxy

14. Judiciously,along with IDT, seeks specialty consultation and refers and utilizes provider network specialists based on medical necessity

15. Participates in the development and revision of the participant’s plan of care as a member of the IDT. Integrates the primary care treatment plan into the overall plan of care developed by the IDT. Interacts with other team members to meet emergent and acute needs of participants. Participates in discharge planning and transfers to alternative level sof care.

16. Participates in quality management program activities as identified on the QAPI plan,including internal auditing and peer review.

17. Documents accurate diagnoses and changes in the participant’s condition and details care provided by completing all required PACE documentation and ensuring compliance with Agency, state and federal standards and policies on health care documentation, including required hospital and nursing home documentation, medical oversight and care coordination.

18. Collaborates with other nurse practitioner(s) and physicians to ensure comprehensive and continuous care.

19. Provides acute care inpatient consultations, assuring care coordination throughout inpatient stay and discharge.

20. Maintains clinical privileges at contract facilities as needed.

21. Assists in monitoring the medical care of enrolled members who are hospitalized or treated in out-of-network and out-of-service area facilities, and assists in their transfer to in-network facilities/providers when medically appropriate.

22. Provides periodic on-call coverage, as secondary contact after RN staff, per the medical coverage schedule, also including availability for hospital admissions, clinic hours at the center, nursing home, emergency room, or home visits to avoid unnecessary hospitalization.

The above examples of work may not be a complete statement of all assignments that may be inherent to the position. Other duties may be assigned as deemed necessary and appropriate by the Medical Director, Program Director, or President and CEO.

MINIMUM REQUIREMENTS:

• Current New York State registered nursing license.
• Certified in New York State as a Nurse Practitioner; geriatrics preferred.
• Satisfactorily completed all education requirements to practice in NYS.
• Experience in the supervision of a multidisciplinary staff within a health care setting or human services agency preferred.
• One year career experience with the care of the frail elderly required.
• Able to lift a minimum of 40 pounds, perform one person transfer under routine and emergency situations, reposition a patient alone, and able to sit, stand, bend, stoop, kneel, pull, climb, reach, lift, and perform repetitive movements of the upper extremities.
• Effective oral and written communications; able to meet the transportation requirements and needs applicable to the position’s duties; functions and responsibilities; electronic medical record; use of telephone at home/off site; Certification in CPR and annual re-certification required;
• Acceptable driver’s license and automobile available for use with current insurance.
• Desired Requirements: Demonstrated skills in working in interdisciplinary team setting; general knowledge, familiarity and understanding of federal PACE regulations and state manage long term care regulations.
• Maintains applicable licensure and certification and pursues professional growth through continuing education process. Optionally holds membership in professional organizations.

Job Types: Full-time, Part-time

Experience:

• EMR systems: 1 year (Required)
• nurse practitioner: 1 year (Required)
• Frail Elderly: 1 year (Required)

License:

• Advanced Practice Registered Nurse (APRN) (Required)

Work Location:

• One location

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Retirement plan
• Paid time off
• Tuition reimbursement

Working days:

• Friday
• Thursday
• Wednesday
• Tuesday
• Monday

Environment:

• Outpatient

Employer type:

• Clinic

Qualifications:

• NP

Completed license needed:

• Upon starting work

Patient Type:

• Geriatric
• Adults

Work from Home:

• No

Relocation Assistance Provided:

• No

Interested candidates can send resumes and cover letters to:
Employment@homecare-hospice.org

For any questions or for more information, please contact Human Resources at (716) 372-2106