Details/Responsibilities:
- Full-time, Mon - Fri, 8am-5pm
- Deliver high-touch, high-quality care to the highest risk patients within their homes
- This role is supported by a scribe/medical assistant, nurse, social worker, and other resources.
- NPs make 6-7 visits daily in a defined territory and collaborate continuously with other team members for care coordination and all other needs.
- APPs in a defined territory collaborate continuously with other team members for post-discharge follow up care coordination, medication reconciliation, and social services follow up.
- Provide post-discharge support according to defined pathways within the patient's home
- Develop care plans and individualize goals of care with patient, their families, and their providers
- Optimize and monitor clinical status, identify and address gaps in care, reconcile medications and address adherence challenges
- Collaborate with Transitional Care Managers, home health, social workers, hospitals, SNFs, and specialists
- Structure and prioritize scheduling based on clinical complexity for both new and routine patients
- Recognize, diagnose, and manage both acute and chronic medical conditions in order to prevent destabilization and readmissions
- Provide after-hours and weekend call support, shared with other in state providers
- Facilitate and conduct goals of care and advance care planning discussions with patients and families
- Assess and evaluate family / caregiver needs and limitations
- Teach patients, caregivers, and others about their health conditions
- Accurate and timely documentation of patient encounters in electronic medical records
- Champion compliance and dissemination of policy, including HIPAA, Patient Identification, and Incident Reporting
- Other duties, as assigned
Qualifications:
- Have an active, non-probationary state medical license, including US work authorization, if applicable
- 1+ years APN experience, preferably with a Medicare population
- Experience in home-based care (as RN or APP) preferred
- Flexibility to travel throughout service area
- Electronic Medical Record experience
- Computer skills: Ability to quickly navigate and use multiple computer programs to include, but not limited to: Gmail, MS Word or Google Docs, Excel or Google Sheets, etc.
- Additional language proficiency in Spanish, Polish, Russian, or other languages spoken within the communities we serve preferred but not required
Compensation & Benefits:
- Competitive Salary
- Paid vacation, sick time, and investment/retirement 401K match options
- Health insurance, vision, and dental benefits
- Opportunities for leadership development and continuing education stipends
- New centers and flexible work environments
- Opportunities for high levels of responsibility and rapid advancement
The Community:
Nestled in a picturesque region known for its rolling farmland and rich history, this area offers a charming blend of small-town warmth and modern conveniences. Residents enjoy a slower pace of life with access to vibrant local markets, historic sites, and a strong sense of community, all surrounded by scenic landscapes perfect for outdoor activities. The cost of living is affordable, making it ideal for families, professionals, and retirees alike. Conveniently situated within a short drive of major cities like Philadelphia, Harrisburg, and Baltimore, it provides easy access to urban job markets, cultural attractions, and entertainment, while allowing you to come home to peaceful neighborhoods and a welcoming atmosphere. Whether you’re seeking tradition, tranquility, or connectivity, this region offers a balanced and fulfilling lifestyle.
APPLY NOW or TEXT Job #CMW231890 and email address to 636 - 628 - 2412.
Search all of our provider opportunities at:
brittmedical DOT com
