Job Description

Job Details

The APC for Clinical Risk Assessments will conduct clinical visits through telehealth and in-home visits with patients identified in the health system with high medical risk factors and suspected care gaps. The APC will conduct a comprehensive assessment of medical conditions and provide care as needed including chronic disease management, preventive care, and any acute needs. The APC will consistently carry out complete and accurate documentation in the medical record and communication of ongoing care needs to the primary care provider (PCP). As schedule allows, the APC may also participate in other service types within Jefferson Primary Care, including Supplemental Access Visits and/or coverage of other clinical services both telehealth and in-home.

Assessment & Management

• Performs complete history & physicals and documents in the medical record.
• Orders and collects data using appropriate assessment techniques, relevant supporting diagnostic information and diagnostic procedures where indicated.
• Assesses for risks associated with the care of the acute and complex chronically ill patient including: medication side effects, immobility, impaired nutrition, fluid and electrolyte imbalance, immunocompetence, invasive interventions and diagnostic procedures.

Diagnosis

• Collaborates with interdisciplinary health care team in making diagnoses of acute and complex chronic conditions.
• Manages diagnostic tests through ordering, interpretation, performance, and supervision.
• Formulates differential diagnoses by priority.
• Diagnoses complications and orders appropriate interventions.

Formulates Plan of Care

• Utilizes evidenced based practice guidelines and protocols in an individualized, dynamic plan of care that can be applied across the continuum.
• Shared proposed plan of care with existing care team, including PCP.
• Identifies health-related social needs and collaborates with care team to support from high socioeconomic risk factors.

Documentation

• Documents/dictates key components of patient's progress via daily progress note, transfer, and discharge summary, and or clinic note where applicable in Epic (EMR). (SOAP, daily progress notes, plan of care, problem lists, procedure notes, acute event note, discharge summaries, in medical record per specific patient unit or service, death summary)
• Documentation is timely, meets acute care compliance standards and captures patient acuity.

Communication and Collaboration

• Maintains ongoing communication and collaboration with interdisciplinary health care team.
• Facilitates and communicates with patient, family and staff to promote continuity of care across the inpatient and outpatient continuum of care.

Professional Practice

• Demonstrates Professional Practice behaviors including: preceptor/mentoring, education and instruction of graduate students.
• Seeks opportunities for active engagement in research and the analysis of evidenced based practice.
• Actively participates in Advance Practice Grand Rounds and specialty specific meetings.
• Maintains CEUs, and membership in a professional organization.

Qualifications:

• Master’s Degree
• National Board Certification as a Primary/Family Care Nurse Practitioner or Physician Assistant
• Licensure in PA is required; multi-state licensure is encouraged
• Must have means of transportation to accommodate home visits (mileage is reimbursed)
• Must reside within Southeastern Pennsylvania area
• BLS certification
• Home-based care experience is encouraged
• Telemedicine experience is encouraged

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Methodist Associates in Healthcare, Inc. (d/b/a Jefferson Community Physicians)

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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