Advanced Practice Provider (APP/NP)

Monogram Health is looking for skilled Nurse Practitioners and Physician Assistants to join an integrated Care Team that includes a Registered Nurse and a Social Worker. The patients served often struggle with multiple serious diseases, and the role focuses on improving their quality of life at home while slowing the progression of kidney disease.

About the role

As an Advanced Practitioner, you will deliver personalized, compassionate medical care primarily to patients with Chronic Kidney Disease (CKD) and/or End-Stage Renal Disease (ESRD/ESKD). The position emphasizes patient-centered, value-based care, allowing you to spend meaningful time with those in your care. This role is remote within the state of employment, with periodic travel required for training or meetings outside the state.

Responsibilities

• Conduct comprehensive annual wellness exams in patients' homes and virtually.
• Counsel and educate patients and families about available health programs and benefits.
• Document patient records, including chief complaints, diagnoses, medical history, examinations, medications, allergies, assessments, and treatment plans.
• Coordinate care with primary care providers, specialists, and ancillary services.
• Complete all documentation and paperwork in a timely manner while maintaining quality of care standards.
• Deliver evidence-based care to reduce avoidable hospitalizations, maximize quality of life, and prioritize patient health and satisfaction.
• Prescribe medications, order tests, and collaborate with the patient’s Monogram physician.
• Perform effectively to improve patient quality outcomes, measured and reported daily.
• Close gaps in care by educating patients on preventive monitoring and scheduling diagnostic testing.
• Assist patients with accessing educational videos and enrolling in relevant programs.
• Participate in integrated care team meetings.
• Assess patient health status, develop and implement treatment plans, and follow up to evaluate progress.
• Knowledge of disease diagnosis, prevention, and treatment.
• Other duties as assigned.

Requirements

• Active and unrestricted Registered Nurse and Nurse Practitioner or Physician Assistant license.
• Board certification for appropriate licensure (NP: ANCC/AANP; PA: NCCPA).
• Current and unrestricted DEA certificate.
• Ability to work autonomously without direct supervision.
• Access to transportation, a valid driver’s license, and car insurance.
• Proficiency with medical instruments and equipment required for the role.
• Knowledge of computer-based data management programs, medical records, and point-of-interview technology.
• Strong verbal and written communication skills for interacting with patients, families, physicians, and community representatives.
• Sound understanding of federal and state regulations, including HIPAA and OSHA.
• 2 or more years of direct patient care experience.
• Experience in managed care, IPA, or health plans.
• Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home.

Bilingual (English/Spanish) is highly preferred.

Benefits

• Flexible scheduling with hybrid and in-home modes.
• Competitive compensation consistent with MGMA guidelines.
• Comprehensive medical, dental, vision, and life insurance.
• Paid vacation and holiday time (20 PTO days, 7 paid holidays, and 1 floating day).
• 401(k) plan with matching contributions.
• Paid relocation assistance (location and case dependent).

About Monogram Health

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for patients with multiple chronic conditions. The company takes a comprehensive and personalized approach to health, treating not only diseases but also addressing conditions like diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, including specialists in nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care. The company is available 24/7 to support and treat patients in their homes, improving outcomes and quality of life while reducing medical costs. Monogram Health operates in 37 states and is headquartered in Nashville, Tennessee.