Nurse Practitioner - Care at Home - Houston

Job Description

Job Description

Description

We are seeking a highly skilled and compassionate Cantonese-speaking Nurse Practitioner (NP) to join our Care at Home team. The ideal candidate will have expertise in managing patients with complex medical conditions in a home care setting, ensuring high-quality care for individuals who are considered high-risk due to chronic illnesses, multiple comorbidities, and complex healthcare needs. The Nurse Practitioner will work collaboratively with other healthcare professionals to deliver patient-centered care that focuses on keeping patients healthy at home throughout the San Francisco area, enhancing patient outcomes, and improving quality of life for homebound and complex patients. A significant component of the role will be providing supportive/palliative care to appropriate patients, ensuring symptom management and holistic support for those with serious illnesses.

This position offers an exciting opportunity for a Nurse Practitioner to make a significant impact on the lives of patients with complex needs, providing care in the comfort of their own homes in the Houston area.

Our Values: 

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Patient Care & Assessment: 
  • Conduct comprehensive health assessments, physical examinations, and diagnostic evaluations for patients in their homes.
  • Complete transitions of care post-discharge. 
  • Develop individualized care plans for high-risk patients, considering their medical history, comorbidities, and functional status.
  • Prescribe and manage medications, including managing complex drug regimens for chronic conditions such as heart failure, diabetes, COPD, and more.
  • Perform health screenings and provide preventive care to help minimize hospitalizations and emergency room visits.
• Palliative Care Management:
  • Assess patients for eligibility and appropriateness for palliative care, focusing on symptom management and quality of life for individuals with serious or life-limiting conditions.
  • Provide compassionate palliative care to improve comfort, alleviate pain, and address psychological, emotional, and spiritual needs for patients and their families.
  • Collaborate with the palliative care team to develop care plans that align with the patient's goals, preferences, and values.
  • Educate patients and families on palliative care options, including advanced care planning, pain and symptom management, and end-of-life care.
  • Monitor and adjust palliative interventions based on patient needs, ensuring a holistic approach to care that includes physical, emotional, and social well-being.
• Collaboration & Coordination:
  • Collaborate with interdisciplinary teams, including physicians, social workers, care coordinators, and family caregivers, to provide holistic patient care.
  • Ensure effective communication and care coordination between the home care team and any specialists involved in the patient’s care.
  • Serve as a primary point of contact for patients and their families, providing education, support, and guidance as needed.
• Chronic Disease Management:
  • Monitor and manage high-risk conditions in collaboration with the patient's care team, with a focus on chronic disease management and health promotion.
  • Educate patients and families on disease management, symptom control, medication adherence, and lifestyle modifications.
  • Review patient records regularly and update care plans to adjust to changing conditions or new diagnoses.
• Clinical Documentation & Reporting:
  • Accurately document all patient interactions, assessments, treatments, and progress in the Electronic Health Record (EHR) system.
  • Maintain confidentiality and comply with all relevant healthcare regulations and standards (e.g., HIPAA).
  • Participate in team rounds on patient progress, interventions, and outcomes.
• Patient Advocacy & Support:
  • Advocate for patients’ rights and ensure that they receive the best possible care and services in the home setting.
  • Address any concerns or challenges that arise in the home care environment, ensuring patient safety and satisfaction.
  • Support patients and families with end-of-life planning, palliative care needs, and grief counseling when appropriate.

Qualifications

• Current, unrestricted Nurse Practitioner license in TX and Furnishing License
• Certification as an Adult-Gerontology Nurse Practitioner (AGNP) or Family Nurse Practitioner (FNP), with additional certifications or experience in relevant specialties (e.g., palliative care, wound care, gerontology) preferred.
• Strong understanding of home health care protocols, chronic disease management, palliative care, and geriatric care.
• Ability and willingness to travel to patient homes. 
• Ability to independently assess and manage patients in home settings with minimal supervision.
• Excellent communication and interpersonal skills, with the ability to work collaboratively in a multidisciplinary team.
• Ability to use electronic health records (EHR) systems and other clinical tools proficiently.
• Knowledge of state and federal regulations governing home care services.
• Strong critical thinking, problem-solving, and decision-making skills.
• Ability to work with patients from various cultural backgrounds, ability to utilize translational services.

You’ll be great for this role if you have:

• Minimum of 3-5 years of experience in a clinical nursing role, with a focus on high-risk, complex patients 
• Experience caring for patients in their homes or palliative care experience 
• Experience in HEDIS and HCC

Environmental Job Requirements and Working Conditions

• This is a full-time, hybrid position, where you will be expected to travel to patient homes and perform telehealth visits from home, M-F 8 A - 5 P. Our patient population is located primarily throughout Houston.
• The total compensation target pay range for this role is between $130,000 - 170,000 annually. This pay range represents our national target range for this role. Total compensation will be evaluated based on experience, certifications, and skillsets.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at View email address on ziprecruiter.com to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.