APRN/PA Jacksonville, FL (Primary Care Full-time)

How Will You Make An Impact & Requirements

The Primary Care Office Advanced Practice Provider (APRN or PA) is responsible for providing total care for patients assigned in collaboration with the physician of record and members of the patient care team. The APP must hold a license in good standing with the State of Florida. The APP will communicate and manage the patients' care across all care providers, family, and caregivers. The APP will ensure timely, patient-centered, appropriate evidence-based medicine is provided for patients with acute, chronic, and palliative care needs.

• Perform patient assessments and care planning, risk management plan development, addressing quality measures and HCCs, and providing acute interventions, chronic care management, and palliative care services within their scope of practice.
• Provide services to meet patient needs and prevent unnecessary Emergency Department utilization when appropriate.
• Ensure all pertinent and active medical conditions are documented in the electronic medical record in a timely manner, consistent with Millennium Physician Group (MPG) policy, and in a compliant manner with Centers for Medicare & Medicaid Services (CMS) and other insurance carriers.
• Exhibit strong clinical skills to improve patient care for an aging, adult population; as well as excellent interpersonal relationship skills in interpreting and communicating health care information to the patient, family, and patient care team.
• Provide leadership in the application of the nursing process to client care, organizational processes and/or systems improving outcomes at the program or service level and initiates interdisciplinary projects to improve organizational performance.
• Identify patients who are appropriate and would benefit from skilled nursing/therapy and initiate appropriate process for qualifying value-based patients.
• Follow all CMS guidelines and ensure patients are admitted to a qualifying SNF.
• Complete all required documentation and work with other members of the health care team to ensure continuity and patient safety.
• Instruct and counsel patients regarding compliance with prescribed therapeutic regimens and health maintenance.
• Accountable for identifying patients needing additional assistance and making referrals to home care, social services, behavioral health, and other available community resources, when needed and appropriate.
• Works collaboratively with Program Manager in overseeing assigned Medical Assistant and establishing workflow processes, provisions of ongoing education/training, and employee improvement planning as needed.

Essential Duties and Responsibilities

• Is responsible for the total care of all assigned patients in collaboration with the community-based physician/provider and patient care team.
• Is responsible for patient assessments and care planning, risk management plan development, addressing quality measures and HCCs, and providing acute interventions, chronic care management, and palliative care services within their scope of practice.
• Provides services to meet patient needs and prevent unnecessary Emergency Department utilization when appropriate.
• Ensures all pertinent and active medical conditions are documented in the electronic medical record in a timely manner, consistent with Millennium Physician Group (MPG) policy, and in a compliant manner with Centers for Medicare & Medicaid Services (CMS) and other insurance carriers.
• Exhibits strong clinical skills to improve patient care for an aging, adult population; as well as excellent interpersonal relationship skills in interpreting and communicating health care information to the patient, family, and patient care team.
• Provides leadership in the application of the nursing process to client care, organizational processes and/or systems improving outcomes at the program or service level and initiates interdisciplinary projects to improve organizational performance.
• Identifies patients who are appropriate and would benefit from skilled nursing/therapy and initiates appropriate process for qualifying value-based patients.
• Follows all CMS guidelines and ensures patients are admitted to a qualifying SNF.
• Completes all required documentation and works with other members of the health care team to ensure continuity and patient safety.
• Instructs and counsels patients regarding compliance with prescribed therapeutic regimens and health maintenance.
• Accountable for identifying patients needing additional assistance and making referrals to home care, social services, behavioral health, and other available community resources, when needed and appropriate.
• Works collaboratively with Program Manager in overseeing assigned Medical Assistant and establishing workflow processes, provisions of ongoing education/training, and employee improvement planning as needed.

Qualifications

• Completion of master’s degree in nursing; two or more years related experience and/or training preferred; or equivalent combination of education and experience.