Location: Bronx,NY, USA
GENERAL JOB SUMMARYAn exempt clinical position where the nurse practitioner (NP) is responsible for providing direct patient care. The NP participates as a leader of the skilled nursing facility (SNF) care team. Visits managed care and fee-for-service patients at skilled and long-term levels of care in designated SNFs facilities. Provides appropriate evidence-based geriatric medicine. Coordinates care with hospitalists, primary care physicians and care managers. Makes home visits as directed by the medical staff to meet patient needs and provide continuity of care.ESSENTIAL JOB FUNCTIONSMaintains privileges in multiple Nursing Homes as directed by ACAMaintains license and malpractice insuranceConsults supervising attending as neededDocuments patient visits electronically at least 90% of the timeParticipates in documentation and other quality improvement programsAvailable via phone weekdays 8am- 7pm and when on call.Will reviews, approves, and modifies admission ordersCreates a detailed admit note for each admission within 24 hours of patient admission to SNF, including medication reconciliationInitiates/documents Advanced DirectivesDetermines if Health Care Proxy status is correct and invoke if appropriateOn weekends, takes call for admissions and see new patients within 24 hours of admission on a rotating basis with other practitioners in the program.Daily VisitsInitiates and review orders, including medications, on a daily basisReviews labs, radiology reports, and consults on all patientsTalks to and examines each assigned skilled-level patient on daily rounds Monday through FridayWrites at least one daily progress note for each skilled patientAssess patient's medical stability daily. Consults/coordinates with specialists as neededAddresses acute mental status changes via non-pharmacologic or pharmacologic measures, consultation or transferCoordinates/assess rehab progress on a daily basisDiscusses concerns with the patient, family, rehab, and case management. Educates patient and family members regarding acute and chronic illness managementAttends family meetings as necessaryAssists PCP's that participate in SNF managementInforms attending and/or ACA medical director of significant changes in medical conditionParticipates in weekly utilization meetings, collaborating with the SNF care team and ACA care managersCoordinates with PCP's, Hospitalists, ACA Medical Directors and Case ManagersPerforms home visits on selected patientsAddresses /coordinates any legal issues.DischargeDevelops a discharge plan utilizing input from case management and rehab. Identify barriers to dischargeCreates a detailed discharge summary for each admission on all patients, including medication reconciliation, and sends to the PCP at the time of SNF dischargeEnsures that patients have all appropriate drug and DME prescriptions at dischargeCoordinates visits with the PCP post-dischargeDischarges summary to be sent to the PCP at dischargeUpdates all patients in Care Screen™ before dischargeCoordinates transition from skilled to long term placement.Long-Term CareAssists case management in the evaluation of selected long term patientsFollows new long term patients every 30 daysAssists the attending physician with management for complex long-term patientsQualificationsEDUCATION AND EXPERIENCELicense to practice as a Registered Nurse and a certificate to practice as a Nurse Practitioner issued by the State Board of Registered Nursing.Geriatrics specialty certification preferredMinimum of three years of clinical nursing experience preferred, including work in a skilled nursing facility.20 days PTO,Health insurance, 401 k %2,Malpractice insurance.