Nurse Practitioner/Physician Assistant
About the role
This role works within an integrated multidisciplinary care team (Clinical, Behavioral Health, Pharmacy, Administrative), establishing long-term patient relationships and providing continuity of care to complex patients in their homes and via telehealth. The Advanced Practice Provider has the opportunity to be part of a value-based, patient-centered care model, providing quality driven managed care with a population health focus.
Responsibilities
- Provide evidence-based, patient-focused care that reduces avoidable hospitalizations and improves quality of life directly in the patient’s home
- Perform comprehensive assessments, including initial evaluations, annual wellness exams, follow-ups, acute urgent visits, and post-discharge visits
- Educate patients and caregivers on disease management, preventive care, medications, and diagnostic testing
- Participate in recurring virtual integrated care team meetings
- Engage in quality assurance activities, including audits and documentation reviews, to ensure compliance with state board requirements and clinical best practices
- May practice in a variety of care settings beyond the patient’s home, including skilled nursing facilities (SNFs), assisted living facilities (ALFs), hospitals, and other affiliated clinical settings, as applicable
- Perform point-of-care testing (A1C and Spirometry), prescribe medications, order tests, and collaborate with patient’s Monogram physician
- Care for coordination with PCPs, specialists, and ancillary services
- Complete documentation accurately and in a timely manner
Requirements
- Active and unrestricted RN and NP license, or Physician Assistant license
- Board certification (NP: ANCC/AANP | PA: NCCPA)
- Current and unrestricted DEA certificate, or eligibility to obtain
- Minimum of two (2) years of direct patient care experience
- Field-based role requiring travel to patient homes, reliable transportation, valid driver’s license, and auto insurance
- BLS certification (supported during onboarding)
- Demonstrated initiative and independent, critical thinking, and decision-making skills
- Knowledge of and compliance with federal/state regulations (HIPAA, OSHA)
- Previous experience with EHR systems (e.g. Athena, Salesforce, Epic)
- Previous experience conducting annual wellness or comprehensive visits preferred
- Prior experience with managed care, population health, or value-based care preferred
Benefits
- Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
- Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
- Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.