Millennium Physician Group Jacksonville , FL 32277
Posted 2 months ago
Jacksonville / Duval County
The Primary Care Home Visit Nurse Practitioner is responsible, as part of the patient care team, for the overall patient care management process. An advocate for the patient, the Nurse Practitioner will provide total care for the patients assigned in collaboration with the physician of record and patient care team. The Nurse Practitioner will communicate and manage the patients' care across all care providers, family, and caregivers. The Nurse Practitioner will ensure that timely, patient-centered, appropriate evidence-based medicine is provided. The Nurse Practitioner will assist in addressing outstanding Quality Measures and HCCs as applicable to meet or exceed all quality goals.. The Nurse Practitioner will be responsible for ongoing communication with the Primary Care Provider to ensure continuity and coordination of care. The Nurse Practitioner will complete all documentation and billing in a timely manner, per protocol. Responsible for other duties as assigned.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Is responsible for the total care of all assigned patients in collaboration with the community-based physician/provider and patient care team.
Is responsible for patient assessments and care planning, risk management plan development, addressing quality measures and HCCs, and providing both maintenance care and acute interventions within their scope of practice.
Provides services to meet patient needs and prevent unnecessary Emergency Department utilization when appropriate. In home services include but are not limited to: IV hydration/antibiotic therapy, lab draws, nebulizer treatments, EKGs, wound care, and injections, and utilization of mobile diagnostics as indicated.
Ensures all pertinent and active medical conditions are documented in the electronic medical record in a timely manner, consistent with MPG policy, and in a compliant manner with CMS and other insurance carriers.
Exhibits strong clinical skills to improve patient care for an aging, adult population; as well as excellent interpersonal relationship skills in interpreting and communicating health care information to the patient, family, and Patient Care Team.
Provides leadership in the application of the nursing process to client care, organizational processes and/or systems improving outcomes at the program or service level and initiates interdisciplinary projects to improve organizational performance.
Identifies patients who are appropriate and would benefit from Skilled Nursing/Therapy and initiates the SNF 3 Day Waiver for MACO qualifying patients. Follows all CMS guidelines and ensures patient is admitted to a qualifying SNF. Completes all required documentation and works with SNF Case Manager and other members of the health care team to ensure continuity and patient safety.
Accountable for identifying patients needing additional assistance and making referrals to Home Care, Social Services, Behavioral Health, and other available community resources, when needed and appropriate.
Responsible for direct oversight of assigned Medical Assistant. Works collaboratively with Program Director to establish workflow processes, provisions of ongoing education/training, and employee improvement planning as needed.
Competencies:
To perform the job successfully, an individual should demonstrate the following competencies:
Analysis/Problem Assessment Securing relevant information and identifying key issues and relationships from a base of information; relating and comparing data from different sources; identifying cause-effect relationships.
Compassion
Compliance
Communication
Dependability
Individual Leadership/ Influencing
Innovation
Integrity
Judgment/ Problem Solving
Maximizing Performance
Organizational Awareness
Patient Service Orientation
Planning and Organizing/ Work Management
Results Driven & Execution
Teamwork/ Collaboration
Work Standards
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience Completion of master's degree in nursing; two years' experience.
Language Skills
Mathematical Skills
Reasoning Ability
Computer Skills
Certificates, Licenses, Registrations
Advanced Registered Nurse Practitioner
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. In Home patient visits is a requirement of this position. While performing the duties of this Job, the employee is exposed to outside weather conditions and patient's home environment.
Millennium Physician Group