In-Home Health Assessment NP — Chronic Care Management

Fairview Hospital / Cleveland Clinic; Berlin (PA); On-site; USD 85,000 - 110,000; Full time

Job summary

Fairview Hospital / Cleveland Clinic is seeking a Nurse Practitioner to perform comprehensive in-home health assessments and care management for diverse populations. You will conduct histories, exams, and create individualized care plans to improve outcomes and reduce costs.

You will document findings in electronic health records, collaborate with interdisciplinary teams, educate patients and caregivers, and support in-home care delivery with a patient-centered approach.

Qualifications

• Registered Nurse Practitioner with strong clinical assessment and diagnostic skills.
• Experience managing chronic diseases and creating evidence-based care plans.
• Proficiency with EHR documentation and care management workflows.
• Excellent communication, patient education, and teamwork skills.
• Ability to deliver patient-centered care in an in-home setting.

Responsibilities

• Conduct in-home medical history reviews and physical examinations.
• Assess, diagnose, and manage chronic conditions using evidence-based practice.
• Develop and implement individualized care plans aimed at improving patient outcomes and reducing costs.
• Document clinical findings, assessments, and care plans in electronic health records (EHRs).
• Collaborate with interdisciplinary teams to coordinate patient care.
• Educate patients and caregivers on self-management and health maintenance.

Skills

Clinical assessment

Diagnostic skills

Chronic disease management

EHR proficiency

Tools

EHR systems

Job description

Fairview Hospital / Cleveland Clinic is seeking a Nurse Practitioner to perform comprehensive in-home health assessments and care management for diverse populations. You will conduct histories, exams, and create individualized care plans to improve outcomes and reduce costs.

You will document findings in electronic health records, collaborate with interdisciplinary teams, educate patients and caregivers, and support in-home care delivery with a patient-centered approach.