Advanced Practice Provider, Community Based

AbsoluteCare; Cleveland (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

AbsoluteCARE in Columbus seeks a Community Based Advanced Practice Provider (APN/PA) to deliver urgent and primary care to members where they live. You will partner with the member’s PCP and care team to transition recently discharged patients, address urgent needs to avoid ER visits, and manage chronic conditions with preventive care.

Responsibilities include medication review, patient education, home care coordination, and comprehensive care planning while maintaining EMR documentation and

Qualifications

• Nurse Practitioner/Physician Assistant with 2+ years of experience.
• DEA license is required.
• Unrestricted medical license in the practicing state is required.
• Experience in care transitions and reducing readmissions is preferred.
• Experience with high-risk, medically complex patients is a plus.

Responsibilities

• Provide community-based medical and care-coordination services for recent hospital discharges.
• Assess patients and manage medications, including comprehensive medication reviews.
• Educate patients and families; coordinate home care services.
• Develop and implement individualized care plans; document in EMR.
• Collaborate with primary care providers and care teams to prevent readmissions.

Skills

Patient-centered care

Care coordination

EMR proficiency

Office software

Education

Active DEA registration

Unrestricted medical license (state)

Tools

EMR systems

MS Office

Job description

Job Summary

This Community Based Advanced Practice Provider, Nurse Practitioner or Physician Assistant in Columbus focuses on providing both urgent and primary care to our members where they live. Working in partnership with the member's primary care provider and interdisciplinary team, the community-based provider is responsible for seeing members recently discharged from the hospital and ensuring a smooth transition of care to prevent readmissions, seeing members who have urgent clinical needs and addressing them so they can avoid a trip to the Emergency Room, and performing chronic disease management and preventive care in conjunction with the center-based primary care team.

Job Summary

This Community Based Advanced Practice Provider, Nurse Practitioner or Physician Assistant in Columbus focuses on providing both urgent and primary care to our members where they live. Working in partnership with the member's primary care provider and interdisciplinary team, the community-based provider is responsible for seeing members recently discharged from the hospital and ensuring a smooth transition of care to prevent readmissions, seeing members who have urgent clinical needs and addressing them so they can avoid a trip to the Emergency Room, and performing chronic disease management and preventive care in conjunction with the center-based primary care team.

Duties And Responsibilities

• Provide community-based medical and care-coordination services for recent hospital discharges
  • Work closely with the transitional care manager and the member's primary care team, following through on the discharge plan with the member.
  • Conduct patient/member assessments.
  • Review, monitor, adjust and discontinue medications.
  • Comprehensive Medication Review for adherence.
  • Patient/Member and family education.
  • Coordinate home care agencies and services.
  • Develop and implement plan of care.
  • Communicate patient's medical, or mental conditions, substance abuse and social determinants of health needs.
  • Document appropriately in the Electronic Medical Record.
  • Gather critical information from member's home environment and coordinates use of this information with healthcare team.
• Work collaboratively with the primary care provider, interdisciplinary office care team and transitional care manager,
• Support safe discharge transition and treatment in the community.
• Intervene with at-risk members to avoid unnecessary hospitalizations.
• Coordinate with care team, patient/member, family, and caregivers to help resolve barriers to care and transition back to Medical Center setting.
• Maintain the security and privacy of all information that is owned by AbsoluteCARE or maintained on behalf of the company's patients, employees, and business partners.
• Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned.

Qualifications

• Nurse Practitioner/Physician Assistant with 2 or more years’ experience.
• DEA
• Unrestrictive medical license in the state of practice
• Multiple settings experience (urgent care, ER, inpatient, office, or community based) preferred.
• Familiar with care transitions, strategies for reducing readmissions and chronic condition management interventions
• Experience working with high risk and medically complex patients with multiple comorbidities preferred.
• Psychiatric and substance use disorder experience helpful.
• Extensive knowledge of local population, geography, and resources.
• Ability to take a creative and innovative approach to problem-solving to aid patients in overcoming barriers to care.
• Ability to meet deadlines and manage multiple priorities.
• Effectively adapt and respond to a complex, fast-paced, and results-oriented environment.
• Knowledge and experience using Electronic Medical Records and ability to analyze and leverage their reporting capabilities.
• Excellent computer skills, including knowledge of Microsoft Office.
• Patient-centered focus.

Working Conditions

This job operates in a patient care setting where there is potential exposure to blood, bodily fluids, and infectious materials. This role routinely uses general office equipment. Often wear a special uniform, such as a lab coat or surgical scrubs, protective or safety attire, such as gloves and masks. High patient traffic, close quartered and shared workspace.

Physical requirements

• Job may be physically demanding at times.
• Remain stationary for long periods of time.
• Repetitious movements.
• Frequently move equipment or supplies weighing up to 20 lbs.

Direct Reports

None

All Employees are expected to maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company's patients, employees, and business partners. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.