PCP Nurse Practitioner

Why work with us? A people-first environment where what matters to those we serve matters to us. Make a lasting impact by enhancing the quality of life for seniors. Access professional growth through training and career development.

About the role

Deliver primary care and continuous healthcare services to PACE participants, assessing, planning, and providing care in alignment with PACE Program standards. Work closely with the clinical care team to conduct assessments, reassessments, develop care plans, and deliver comprehensive primary care.

Responsibilities

• Provide high-quality primary care with a strong focus on individualized evaluation, starting with a comprehensive history and physical exam.
• Collaborate closely with the Interdisciplinary Team (IDT) before referring participants to specialists to ensure necessary referrals and continuity of care.
• Work with the Medical Director to manage specialist referrals, initiate appropriate treatment prior to referral, review specialist notes promptly, and develop participant care plans incorporating clinical judgment and consult findings.
• Manage and monitor all participants' medications, aiming to exceed expectations in medication reconciliation and medication interactions, in conjunction with the Medical Director and collaborating Pharmacist vendor.
• Stay actively informed of participant status during hospitalizations and facility stays, providing guidance to ensure safe transitions and care continuity.
• Assume shared responsibility for all participants in the center, supporting the IDT model of team-based care.
• Participate in and contribute to daily IDT meetings, offering clinical insights and collaborating on participant-centered care plans.
• Ensure accurate, timely completion of all participant assessments and documentation in compliance with policy, regulatory, and quality standards.
• Review and respond to labs, imaging, and consults in a timely manner, incorporating findings into ongoing care plans and communicating changes with the IDT.
• Educate participants and caregivers on self-care strategies, medication use, and wellness practices.
• Use the Emergency Department judiciously, prioritizing PACE resources unless symptoms are potentially life-threatening.
• Accurately document diagnoses with attention to proper coding practices, supporting risk adjustment and quality reporting metrics.
• Provide coverage for the 24/7 on-call rotation, addressing participant needs promptly and ensuring proper hand-offs and communication.
• Contribute to discharge planning, supporting smooth transitions across care settings.
• Assist with staff training and mentoring, contributing to clinical policy development and best practice implementation.
• Participate in ongoing performance and quality improvement initiatives.
• Demonstrate flexibility by stepping into other roles, as allowed by licensure and experience, when needed to support the team.
• Maintain and report clinical resource needs to the Medical Director, supporting effective operations.
• Consistently uphold all safety, privacy, and compliance standards.

Requirements

• MD, DO, NP, APRN, or PA.
• NJ: Nurse practitioners must be certified by the New Jersey State Board of Nursing; physicians must be licensed or authorized by the New Jersey State Board of Medical Examiners.
• Current state license, State CDS Certification, and DEA Registration.
• Board Certified in Geriatrics preferred.
• BLS required (must obtain within 90 days of employment).
• 2 years of experience providing direct patient care (preferred).
• 1 year of experience working with a frail or elderly population preferred; training will be provided if not present.

Pre-employment requirements

• Reliable transportation, valid driver’s license, and minimum state-required liability auto insurance.
• Medically cleared for communicable diseases and up-to-date immunizations before engaging in direct participant contact.
• Pass a comprehensive criminal background check, including federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.

Benefits

• Competitive compensation.
• Medical and dental coverage.
• Flex Time Off.
• 401K with match (begins after one year of employment).
• Life insurance.
• Tuition reimbursement.
• Flexible Spending Account.
• Employee Assistance Program.