Advanced Practice Provider, Community Based
Advanced Practice Provider, Community Based
Posted today
SENIORITY
Senior
About the role
- Provide community-based medical and care-coordination services for recent hospital discharges
- Work closely with the transitional care manager and the member's primary care team, following through on the discharge plan with the member.
- Conduct patient/member assessments.
- Review, monitor, adjust and discontinue medications.
- Comprehensive Medication Review for adherence.
- Patient/Member and family education.
- Coordinate home care agencies and services.
- Develop and implement plan of care.
- Communicate patient's medical, or mental conditions, substance abuse and social determinants of health needs.
- Document appropriately in the Electronic Medical Record.
- Gather critical information from member's home environment and coordinates use of this information with healthcare team.
- Work collaboratively with the primary care provider, interdisciplinary office care team and transitional care manager, Support safe discharge transition and treatment in the community.
- Intervene with at-risk members to avoid unnecessary hospitalizations.
- Coordinate with care team, patient/member, family, and caregivers to help resolve barriers to care and transition back to Medical Center setting.
- Maintain the security and privacy of all information that is owned by AbsoluteCARE or maintained on behalf of the company's patients, employees, and business partners.
- Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned.
- Nurse Practitioner/Physician Assistant with 2 or more years' experience.
- DEAUnrestrictive medical license in the state of practice
- Multiple settings experience (urgent care, ER, inpatient, office, or community based) preferred.
- Familiar with care transitions, strategies for reducing readmissions and chronic condition management interventions
- Experience working with high risk and medically complex patients with multiple comorbidities preferred.
- Psychiatric and substance use disorder experience helpful.
- Extensive knowledge of local population, geography, and resources.
- Ability to take a creative and innovative approach to problem-solving to aid patients in overcoming barriers to care.
- Ability to meet deadlines and manage multiple priorities.
- Effectively adapt and respond to a complex, fast-paced, and results-oriented environment.
- Knowledge and experience using Electronic Medical Records and ability to analyze and leverage their reporting capabilities.
- Excellent computer skills, including knowledge of Microsoft Office.
- Patient-centered focus.
Before you apply
Applying takes about a minute. These four things decide how fast it moves after that.
Your profile is current
It's what we read first. Occupations, seniority and locations matter more than a long history.
Two examples you can talk through
Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.
A number in mind
What you're on now and what would make you move. We negotiate better when we know both.
Your notice period
Employers plan around it, and it's the question that stalls offers most often.
Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.
