Nurse Practitioner - Integrated Home Care

CenterWell • Plant City, FL

8d

About The Position

Integrated Home Care is a dynamic and initiative dedicated to transforming healthcare delivery for high-risk patients in the comfort of their own homes. We try to reduce avoidable hospitalizations and readmissions by providing comprehensive, patient-centered care to individuals with medical complexity and functional limitations. Our diverse team delivers proactive, coordinated care directly where our patients need it most. As an advanced practice provider (APP) within integrated home care, you will help enhance the well-being of frail, medically complex, and often homebound patients. You will conduct comprehensive in-home assessments, develop individualized treatment plans in close collaboration with the patient's care team, and leverage both in-person and telemedicine capabilities to deliver care. Your expertise will directly help enhance patient outcomes, reducing acute care utilization, and promoting a higher quality of life for our vulnerable patient population. You will cover the hub of Plant City, Zephyrhills, Winter Haven, and Lakeland.

Requirements

• Must be a nurse practitioner or physician assistant with minimum of five years of experience in acute care, geriatrics, palliative care, or a related field.
• You will need to have demonstrated experience working with geriatric patients and their families in the home setting, with a commitment to providing compassionate and patient-centered care.
• Experience and comfort with advance care planning and end-of-life discussions.
• You will need experience ordering medications in the home setting.
• You will need to have prior experience with building relationships and trust with patients, families, and colleagues.
• You will need to excel in a collaborative, diverse team environment, contributing your expertise and working with diverse professionals.
• You need to use electronic medical record (EMR) systems for accurate and efficient documentation.
• You must be board certified as a nurse practitioner or a physician assistant with a clear and active Florida license, or obtain the license.

Responsibilities

• Conduct comprehensive in-home evaluations and examinations by performing assessments of enrolled patients, focusing on their medical, functional, and psychosocial needs.
• Develop and implement personalized treatment plans by collaborating with primary care physicians and other members of the interdisciplinary team to create treatment strategies tailored to each patient's unique circumstances. Co-management with the patient's PCP.
• Educate and empower patients and families by providing education about their conditions, treatment options, medications, and the benefits of integrated home care, empowering them to participate in their care.
• Manage acute clinical issues in the home: Diagnose and treat urgent conditions, such as pneumonia, CHF/COPD exacerbations, UTIs.
• Administer and monitor medication administration in the home setting, following established protocols and ensuring patient safety.
• Maintain accurate documentation by documenting all home visits, assessments, interventions, and communications within our Electronic Medical Record (EMR) system, Athena
• Participate in medical team meetings by contributing to collaborative discussions, sharing insights, and participating in care planning during scheduled team meetings on a rotating basis.
• Based on coverage area, you will have a caseload of 45-50 patients in a given month, ~200 unique patients per year, completing six-eight visits per day, establishing a weekly or every-other-week cadence of visits with patients in the caseload.
• Share after-hours call responsibilities and provide telemedicine consultations to patients and families as part of a rotating on-call schedule.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed