CareCoach Connect Nurse Practitioner - WellMed - Fort Worth, Burleson, Cleburne, TX

Must be open totravel within an hour of your home location

*Example cities of patient care include *Fort Worth, Burleson, Cleburne, TX but this is not an exhaustive list**

A partner of the Optum Care network, WellMed Medical Group, is seeking a CareCoach Connect Advanced Practice Clinician (APC) to provide both longitudinal and episodic medical care to mostly Medicare-aged patients on a Medicare Advantage plan. The APC will conduct visits in patients’ homes and virtually to manage their acute and chronic conditions. The APC collaborates with the lead collaborating physician to formulate a diagnosis and appropriate plan of care.

Position Highlights:

• Provide care in patient’s homes and virtually consistent with their licensure and/or certification.
• Diagnose and treat both acute and chronic conditions such as diabetes, hypertension, kidney disease and other chronic medical conditions. The APC will also treat acute conditions such as injuries and other medical conditions such as infections or exacerbations of chronic disease.
• Order and interpret diagnostic lab work, x-rays, EKG.
• Prescribe pharmacological and non-pharmacological interventions for both acute and chronic conditions.
• Perform procedures based on the patient’s condition (ex: place IVs, wound debridement, joint injections, vaccinations, etc.)
• Collaborate with lead M.D./D.O, specialists, other health care team members, the patient and family in developing a plan of care.
• Determine effectiveness of interdisciplinary treatment plan, evaluate patient response, and revise plan of care accordingly including program designation, discharge planning and frequency of visits and visitors.
• Communicate effectively with patients and families for understanding of diagnosis, prognosis, and treatment plans.
• Oversee census of longitudinal care patients and manage them with the team on a regular basis (census may change regularly due to geographic catchment area changes).
• Transition appropriate patients to hospice or back to usual care when clinically necessary.
• Perform transition of care evaluations and acute visits for patients when clinically necessary.
• Prepare and maintain accurate patient records, and documents.
• Provide education to patients and families regarding chronic disease management, symptom management and quality of life expectations.
• On-Call responsibilities as required.

Required Qualifications:

• Graduate of an accredited Nurse Practitioner or Physician’s Assistant Program
• Current Licensure through the State Board of Nurse Examiners or State Medical Board
• Current prescriptive authority from the State Board of Nursing or State Medical Board
• Comfortable with chronic condition management for Medicare-aged population
• Must have a valid driver’s license within the state of work
• Position will require a minimum of 25% travel and overnight trips with hotel stay
• Ability to establish effective working relations with patients and their families

Preferred Qualifications:

• 2+ years internal medicine/family practice with geriatric care experience
• Home health experience
• Knowledge of Palliative care and end of life symptom management
• Bilingual (English/Spanish) language proficiency preferred
• Ability to assess the physical, and psychosocial, status of geriatric populations
• Ability to work independently and interdependently with the interdisciplinary team, showing initiative and motivation