In-Home Palliative NP/PA: Lead Compassionate Care

Monogram Health Professional Services; Louisiana; Hybrid; USD 125,000 - 162,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with employer match

Paid time off and holidays

Job summary

Monogram Health is seeking a full-time Palliative Care Advanced Practice Provider to join the team delivering in-home care for highly complex patients, including end-of-life patients with CKD/ESRD, diabetes, COPD and CHF.

The APP will work with the Market Physician Executive and an interdisciplinary team to provide palliative care, symptom management, care planning, and documentation of advance directives to ensure patient-centered care in home and virtual settings.

Qualifications

• Active and unrestricted Nurse Practitioner or Physician Assistant license.
• Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA).
• Current and unrestricted DEA certificate.
• Ability to work without direct supervision and practice autonomously.
• Must possess reliable transportation and the ability to travel within the designated region to meet patient needs including in-home and clinic visits as needed. Access to transportation, a valid driver's license, and car insurance
• Active state-specific licensure and willingness to become licensed in multiple states as company and patient needs require
• 2+ years working with patients in a palliative care setting; other relevant experience will be considered

Responsibilities

• Collaborate with Market Physician Executive and clinical leaders to proactively identify patients who qualify for palliative care services and build a patient panel
• Develop individualized care plans in collaboration with Market Physician Executive and other clinical leaders including Palliative Care physician to ensure patients are placed on appropriate evidence-based interventions and pathways
• Provide compassionate, patient-centric palliative care primarily through in-home visits, with virtual care as needed, to support outcomes and care in alignment with patient’s goals
• Evaluate and treat symptoms that may interfere with quality of life, like pain, pruritus, depression, anxiety, insomnia, etc.
• Collaborate with pharmacists and other clinicians to manage medication panels for complex patients
• Provide resources and educate patients and their families on the progression of CKD, ESKD, and related conditions, including treatment options and palliative care principles
• Help families navigate complex medical decisions and improve understanding of prognosis, including advance care planning to discuss values, goals of care, and document patient/family wishes in state AD/POLST forms
• Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first
• Support patients utilizing our interdisciplinary team, including Palliative Care Chaplain
• Assist with transition to hospice care as appropriate
• Participate in monthly meetings with clinical leadership to drive Program KPIs and support execution of clinical and financial goals
• Educate and support team members on palliative care, hospice care, advance directives, symptom assessment, and communication
• As needed for patient care, conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment
• Counsels and educates patients and families about benefits and programs available to help them live healthier lives
• Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan. Completes all documentation and paperwork in a timely manner
• Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services
• This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state
• Prescribe medications, order tests, and collaborate with patient’s Monogram physician
• Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily
• Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing
• Assists patients with enrolling to access educational videos
• Participates in the integrated care team meetings
• Make assessment of patient's health status and develop treatment plan
• Implement a plan consistent with patient’ goals of appropriate plan of care
• Follow-up and evaluate patient's status
• Other duties as assigned

Skills

Active NP/PA license

Board certified (ANCC/AANP or NCCPA)

DEA certificate

Autonomy to practice

Reliable transportation

Multi-state licensure willingness

Palliative care experience (2+ yrs)

Job description

Monogram Health is seeking a full-time Palliative Care Advanced Practice Provider to join the team delivering in-home care for highly complex patients, including end-of-life patients with CKD/ESRD, diabetes, COPD and CHF.

The APP will work with the Market Physician Executive and an interdisciplinary team to provide palliative care, symptom management, care planning, and documentation of advance directives to ensure patient-centered care in home and virtual settings.