Home Visit APRN/PA - Henry and Glades County

Home Visit APRN or PAAs a day-to-day clinical leader, you will provide support and care during patient transitions from acute to home, directing the multidisciplinary team.Primary functions include:Performing 6-8 preventive visits daily to optimize chronic conditions, assess home environment, educate patients and caregivers, and develop proactive care plans.Performing timely new care visits and follow up care as needed in the home, with a focus on avoiding unnecessary ED transfers and hospital admissions.Assuming responsibility as interim provider and driving care and continuity for patients when there is no existing PCP.Co-managing patients with existing PCPs and serving as an extension of clinical care into the home.Coordinating with other physicians across the continuum of care, including PCP, hospitalist, and SNF providers to smooth transitions and prevent readmissions.Coordinating and offering medical direction to community-based organizations, including housing and caregiver agencies, health plan contracted social work services, home health, adult day health centers, and behavioral health.Education, training, and experience required:Active FL medical license in good standing