Impacts value-based care initiatives, including effective utilization of data and analytics to improve patient outcomes.
Delivers comprehensive medical care to complex patients with multiple chronic diseases in the home setting and virtually, conducting thorough assessments, diagnosing illnesses, and developing an individualized plan of care.
Visits patients' place of residence to conduct physical examinations, order and interpret diagnostic tests, prescribe medications, and perform necessary procedures.
Utilizes telemedicine technology to conduct consultations, manage chronic conditions, acute changes, and provide follow-up care.
Collaborates with a clinical care team under the supervision of a Medical Director or Physician Leader, ensuring effective communication among team members and delivery of compassionate patient care that results in improved clinical outcomes and quality of care.
Provides patients and their caregivers with appropriate education and counseling on health-related topics, disease prevention, and lifestyle modifications to promote improved patient experience and outcomes.
Documents patient encounters, assessments, and treatment plans in an electronic health record (EHR) system, ensuring accuracy and compliance with established protocols and privacy regulations.
Manages improvement in health plan and system quality metrics and initiatives for high-risk patients, conducting clinical audits and staying up to date with best practices and medical advancements in clinical care.
Engages in ongoing professional development activities such as attending conferences, CMEs, seminars, and workshops to enhance medical knowledge and proficiency.
Establishes and maintains high standards of quality services including clinical practice standards.
Qualifications
Advanced degree, Nurse Practitioner (NP) or Physician Assistant (PA), from an accredited institution, current national certification, and licensed to practice by the state of the designated work location
Prescriptive authority and other privileges for advanced tasks, as required by the state of the designated work location
Strong clinical skills and ability to manage a wide range of patient conditions and comorbidities
Excellent communication skills, both verbal and written, with the ability to explain complex medical information in a clear and understandable manner
Proficiency in using electronic health record systems and other relevant technologies.
Ability to be committed to patient-centered care, quality improvement, and staying abreast of medical advancements, and best practices
Ability to be flexible and adapt to changing patient needs and healthcare delivery models
Preferred:
5+ years of direct patient care experience
Previous experience in value-based care
Previous experience in home-based care
Previous experience in Medicare
Previous experience in high functioning team-based care delivery models
Working Conditions
Ability to provide care to patients in their homes, both in person and virtually.
Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. Ability to stand for extended periods.
Ability to drive to patient locations (ie. home, hospital, SNF, etc). Fine motor skills/visual acuity.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at PracticeLink by 2x