Nurse Practitioner

Our client's care teams, which include physicians, nurses, social workers, and patient navigators, provide high-touch and comprehensive care to a small panel of CKD and ESRD patients. Team collaboration is essential to their intensive, psycho-social model of care which includes assessment, medication management, social management, and behavioral health management. The Nurse Practitioner will act as part of a care team that directly interfaces with a small panel of patients with CKD stages 3b, 4, 5, and ESRD in order to drive high quality value-based care. He/she will interact with and evaluate patients in the home, via teleconference, or via telephone as appropriate. In this role, the NP will create close working relationships with the patients served and with the care team members. Every day will entail contact with care team members and patients to coordinate optimal care for the patient panel. Location This role provides in-home care across the Maricopa/Casa Grande area. Nurse Practitioners operate as part of a care team and travel to patient residences. This is not an office based or clinic-based position. Work hours Monday–Friday, 8:00 am–5:00 pm What You'll Do Assume medical responsibility for an assigned small panel of patients in collaboration with care team; provide clinical services focused on patient level interventions and system level interventions (both medical and kidney-focused). Complete history and physical exams and order laboratory and diagnostic tests as needed. Educate patients about medication usage and side effects, and prescribe medications as permitted by state prescribing authorities. Identify and manage patients’ medical conditions and obstacles to care. Participate in frequent care team huddles. Educate patients and caregivers about medical conditions and treatment plans. Order diagnostic and laboratory tests and evaluate test results. Determine the need for consultation from medical, surgical, and/or psychiatric specialties. Facilitate care across a variety of settings, including emergency department, hospital, skilled nursing facility, home health agency, hospice, and/or community-based organizations as appropriate. Perform structured assessments and develop and implement comprehensive care plans for the patient panel. Document all medical encounters accurately and in a timely manner. Assist in the development and implementation of clinical protocols and guidelines of care in order to optimize outcomes. Maintain confidentiality in regards to all patient sensitive information. Support company efforts of continuous quality improvement. Adhere to all company policies and procedures. Requirements Licensed Advanced Practice Nurse (APN) in the state of Arizona. Must meet our client's clinician credentialing criteria, including passing a background check Reliable transportation and a verifiable good driving record. Must be able to travel to patient homes. Must be self-motivated and able to perform work in accordance with defined operating procedures. Ability to develop and maintain inclusive and equitable relationships with patients, caregivers and staff. Experience working with community resources from diverse backgrounds. Ability to communicate effectively both orally and in writing. Must be comfortable interacting with patients and care teams both telephonically and in-person. #J-18808-Ljbffr