• Independently assesses acute and non-acute clinical problems. Performs and documents physical assessments and patient histories, analyzes trends in patient conditions, and develops, documents and implements a patient management plan in response to the data obtained. This also includes assisting in the development of the nursing plan of care in addition to providing appropriate patient/ family/significant other counseling and education.
• Plans patient care based on in-depth knowledge of the specific patient population and/ or protocol, anticipating and identifying physiological and/ or psychological problems commonly encountered including the consideration of the patient’s cultural background, level of understanding, personality and support systems. Serves as patient advocate.
• Patient management includes the following:
• Writes admission, transfers and discharges orders.
• Orders and interprets appropriate laboratory and diagnostic studies.
• Orders of appropriate medication and treatments.
• Refers patients for consultation when indicated i.e. dermatology, neurology, ophthalmology, endocrine, surgery, intensive care, infectious disease, hematology, psychiatry, social service, dietary, etc.
• Documentation through in-depth progress notes and summaries.
• May perform invasive procedures independently upon the completion of documented competency.
• Participates in patient care rounds and conferences. Communicates patient management strategies to members of the patient care team. Collaborates with members of the multidisciplinary team to ensure that patient management strategies are successful in meeting patient care needs.
• Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.
• Uses advanced communication skills to problem solve complex situations and to improve processes and service to patients.

Other Responsibilities may include:

• Collaborates with other multidisciplinary team members to analyze and evaluate current systems of health care delivery to identify and implement new practice patterns as appropriate.
• Participates in outside activities that enhance personal and professional growth and development.
• Initiates arrangements and writes orders for SNF discharges and completes appropriate paperwork.
• Works collaboratively with physicians, nurses, PT, social workers, family and key caregivers to transition the patient to a lower level of care as soon as medically appropriate.
• Introduces self to patient/family and explain nurse practitioner role.
• Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify post-SNF needs.
• Enhances a collaborative relationship to maximize the patient’s/family’s ability to make informed decisions re: goals of care, palliative care and hospice.
• Facilitates discharge to appropriate level of care and uses preferred providers when additional services are required.
• Prescribes medication to patients based on State of practice.
• Other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Demonstrated record of consistently achieving clinical performance metrics in current role
• Strong Critical Thinking and problem-solving skills
• Excellent communication and interpersonal skills
• Time management skills with the ability to work well under pressure
• Must be caring and empathetic and have great listening skills
• Must be detail-oriented, and able to pay close attention to patient charts, medications, and follow-up on details of patient care
• Basic computer skills and some knowledge of Microsoft Office Suite
• This position may require 50-75% of local travel