Advanced Practice Practitioner (NP/PA) - 0765

Overview

Grace at Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day.

Duties & Responsibilities

• Deliver comprehensive and follow-up care through in-home and virtual visits, including AWVs, Comprehensive Assessments, Follow-up visits, and TOCs (Transitions of Care) in accordance with Medicare, Medicaid, and commercial plan requirements.
• Practice value-based, home-centered care focused on quality, cost reduction, population health outcomes, and patient satisfaction.
• Provide ongoing management of acute and chronic conditions, collaborating with multidisciplinary teams to develop and implement individualized care plans.
• Participate in daily huddles and interdisciplinary team meetings to enhance patient care coordination.
• Preserve and prescribe medications, therapies, and lifestyle interventions within scope of practice.
• Communicate clearly and compassionately with Family Members, supporting prevention, chronic disease management, and health education.
• Provide on-call backup support to the nurse line in licensed states, requiring additional state licensure for cross-coverage.
• Maintain accurate documentation in the EMR and demonstrate proficiency with practice management systems.
• Ensure compliance with clinical ethics, HIPAA, and all applicable federal and state regulations.
• Participate in quality improvement initiatives, professional development, and other duties as assigned.

Qualifications

• Education/Experience: Master’s degree in nursing or related science field required.
• Certification/Licensure: Active and unrestricted NP/PA license required in the state of hire.
• Clinical: 2+ years of direct patient care as a Nurse Practitioner strongly preferred. Community-based care experience preferred. Experience with Medicare/Medicaid is preferred.
• 2+ Years of Clinical Experience: Treating complex chronic conditions and high-needs patients, Medicare and LTSS experience preferred.
• Skills: Excellent verbal, written, presentation, and group facilitation skills; strong critical analytic, thinking, and communication skills; excellent computer skills required particularly Microsoft applications including Word, Excel, PowerPoint, and Outlook; strong judgment, ethics, and teamwork; willingness to explore and learn new or unfamiliar applications that may benefit the clinical team.