Post by Jobing - The nurse practitioner (NP) is the member of the High Risk Touch Team (HRTT) and is responsible for providing quality care through home assessment of an adult/geriatric and frail populations with Monarch Healthcare. Through their interventions the NP is instrumental in achieving HRTT goals which focus on prevention of hospital readmission and reduction of preventable ER utilization. The NP directly promotes the well–being of senior members and assists Monarch Primary Care Providers (PCP) in the care of their patients by: Identification of overlooked problemsReferral for optimal continuity of careCoach patient complianceEnsure accurate records of chronic conditions Note that daily travel throughout Orange County is required. Mileage is reimbursed per policy.
DUTIES AND RESPONSIBILITIESAdheres to treatment policies, procedures, protocols, and practice guidelines developed by Monarch HealthCare management.Utilizes clinical assessment and disease management skills in conjunction with standardized procedures and the collegial physician–nurse practitioner relationship in order to meet the health care needs of members.Performs comprehensive clinical assessments appropriate to member clinical conditions.Orders appropriate diagnostic testing and discusses potential changes in the treatment plan in collaboration with member's PCP.Records information obtained from the clinical assessment in the electronic health record (EHR) including Hierarchical Condition Coding (HCC) based upon prior data as available and current clinical assessment within 48 business hours.Identifies and initiates referral of other services beneficial to members such as case management or evaluation for palliative care or hospice care. Partners with HRTT social workers to identify and mobilize appropriate resources to support the member and family/caregiver.Coach member/caregiver on the following five pillars of Transitions of Care: Importance of timely follow up with PCP or specialists post–discharge"Red Flags" related to condition (Milliman care guidelines)Medication reconciliation and compliancePersonal Health Record (PHR)End of Life planning: Advanced Directives, POLSTMaintains OSHA Standards and Universal Precautions.Participates in meetings as assigned and attends conferences as required.Regular and consistent attendance.Requirements: QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made for individuals with disabilities. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Competence in management of patients with chronic medical conditions such as congestive heart failure, diabetes, and obstructive lung disease.Minimum one year experience in geriatrics practice or convalescent home.Excellent written and oral communication skills.Cultural and linguistic competence for managing acute and chronic needs of Geriatric patients of diverse ethnicity. LICENSES, CERTIFICATES, REGISTRATIONSCalifornia Registered Nurse license.California Nurse Practitioner Furnishing certificate.National Nurse Practitioner Certification.DEA registration.Medicare UPIN/National Physician Identifier (NPI).California Driver's License.Auto insurance in accordance with State of California law. EDUCATION, TRAINING and/or EXPERIENCE Successful completion of an approved nurse practitioner program.Master's degree.Basic Cardiac Life Support (BCLS) training.Experience as NP with geriatric population. Other Skills and Abilities (desired) Previous experience in the fields of Hospice Care or Palliative Care.Knowledge of Hierarchical Condition Coding (HCC).Knowledge in Transition of Care models.Ability to work independently as well as foster teamwork.Spanish fluency is required.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V Monarch HealthCare is a drug–free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing. Keywords: Home Assessments, Nurse Practitioner, NP, Optum, Orange County, Irvine, bilingual, Spanish See above
Jobing - 16 months ago