APRN​/PA

** Job Description Summary
** The Primary Care Office Advanced Provider (Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) is responsible for and will provide total care for patients assigned in collaboration with the physician of record and members of the patient care team. The Advanced Provider (AP) must hold a license in good standing with the State of Florida. The AP will communicate and manage the patients’ care across all care providers, family, and caregivers.

The AP will ensure that timely, patient-centered, appropriate evidence-based medicine is provided for patients with acute, chronic, and palliative care needs. The Advanced Provider will perform a patient assessment/exam, create a care plan, and provide intervention as indicated. The AP’s role includes diagnosing and deciding treatment for patients, analyzing and interpreting x-rays and lab results, writing prescriptions, taking patients’ histories, providing surgical assistance, and ordering home health, various therapies, and DME as indicated.

The Advanced Provider will provide instruction and assistance on symptom management and advanced care planning for patients with chronic life limiting illness. The Advanced Provider will assist in addressing outstanding Quality Measures and HCCs as applicable to meet or exceed all quality goals. The Advanced Provider will be responsible for ongoing communication with the Primary Care Provider to ensure continuity and coordination of care and is expected to consult with the supervising physician on any complicated diagnosis and treatment decisions.

The Advanced Provider may work with regional Palliative/Hospice Care agencies to facilitate end-of-life care and services when appropriate. The Advanced Provider will complete all documentation and billing in a timely manner, per protocol. Responsible for other duties as assigned.
** How will you make an impact & Requirements
**** Essential Duties and Responsibilities
** include the following. Other duties may be assigned.
* Is responsible for the total care of all assigned patients in collaboration with the community-based physician/provider and patient care team.
* Is responsible for patient assessments and care planning, risk management plan development, addressing quality measures and HCCs, and providing acute interventions, chronic care management, and palliative care services within their scope of practice.
* Provides services to meet patient needs and prevent unnecessary Emergency Department utilization when appropriate.  In home services may include but are not limited to:  IV hydration, lab draws, nebulizer treatments, EKGs, wound care, injections and immunizations, and utilization of mobile diagnostics as indicated.
* Ensures all pertinent and active medical conditions are documented in the electronic  medical record in a timely manner, consistent with Millennium Physician Group (MPG) policy, and in a compliant manner with Centers for Medicare & Medicaid Services (CMS) and other insurance carriers.
* Exhibits strong clinical skills to improve patient care for an aging, adult population; as well as excellent interpersonal relationship skills in interpreting and communicating health care information to the patient, family, and patient care team.
* Provides leadership in the application of the nursing process to client care, organizational processes and/or systems improving outcomes at the program or service level and initiates interdisciplinary projects to improve organizational performance.
* Identifies patients who are appropriate and would benefit from skilled nursing/therapy and initiates appropriate process for qualifying value-based patients.  Follows all CMS guidelines and ensures patient is admitted to a qualifying SNF.  Completes all required documentation and works with other members of the health care team to ensure continuity and patient safety.
* Instructs and counsels patients regarding compliance with prescribed therapeutic regimens and health maintenance.
* Accountable for identifying patients needing additional assistance and making referrals to home care, social services, behavioral health, and other available…