The Advanced Practice Provider (APP) provides in-home post-discharge management for adults at risk for readmission through Transitional Care Management. Home visits give high-risk patients access to proactive, comprehensive, compassionate, and collaborative care intended to improve health and well-being while helping them remain at home. The service area includes Burlington, Camden, and Gloucester counties. APPs practice within applicable state scope-of-practice requirements, clinical privileges, professional standards, and state and federal laws. As licensed independent providers, they practice autonomously and/or in consultation with a collaborating or supervising physician and other health care professionals to assess, diagnose, treat, and manage patient health needs. During home visits, the APP takes patient histories and performs physical examinations, develops working differential diagnoses and individualized plans of care, and may order, perform, supervise, and interpret diagnostic and laboratory tests. Services may include prescribing medications and non-pharmacologic therapies, providing therapeutic measures, and educating and counseling patients, families, and groups. For uncommon or unstable conditions, the APP consults with a collaborating or supervising physician and may refer the patient to a specialist or participate in shared management and treatment. The role also includes health promotion, disease prevention, research, professional education, interdisciplinary consultation, and patient advocacy. The APP maintains appropriate prescribing documentation and follows current prescribing guidelines and applicable laws. The position requires ongoing professional accountability, national certification, periodic peer review, clinical outcome evaluation, ethical practice, continuing professional development, and maintenance of clinical skills. The APP is expected to stay current with medical trends and provide evidence-based care through required continuing education.