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Job Summary:The Nurse Practitioner (NP) is responsible for providing direct patient care in a Long-Term Care, Skilled Nursing Facility. The NP will participate as a leader of the skilled nursing facility (SNF) care team. The NP will provide appropriate evidence-based geriatric medicine and coordinate care with hospitalists, primary care physicians and care managers in providing quality, efficient, continuous, and cost-effective care for the residents of the skilled nursing facility.

Essential Functions & Responsibilities:

• Obtains, records, and dictates medical histories and physical examinations.  
• Makes daily rounds, records progress notes, writes routine orders (comfort and diet, laboratory tests, non-invasive examinations, etc.).
• Performs procedures such as, general wound care, intravenous (IV) therapy, injections, catheter care, physical therapy, and monitoring of vital signs and medical equipment
• Ordering, performing, and interpreting diagnostic tests such as lab work.
• Act as liaison between patients, nurses.
• Requests consults from appropriate physicians.
• Diagnoses and treats acute and chronic conditions such as diabetes, high blood pressure, infections, and injuries.
• Prescribes medications and other treatments.
• Manages patients' overall care.
• Performs other duties as assigned.

SKILLED NURSING FACILITY SPECIFIC

• Maintains privileges in multiple Nursing Homes as directed by ACA.
• Maintains license and malpractice insurance.
• Consults supervising attending and Medical Director as needed.
• Documents patient visits electronically.
• Participates in documentation and other quality improvement programs.
• Available via phone weekdays 8am until 5pm and when on call.
• Participates in on-call schedule.
• Reviews, approves, and modifies admission orders.
• Creates detailed admit note for each admission within 24 hours of patient admission to SNF, including medication reconciliation.
• Initiates/documents Advanced Directives.
• Determines if Health Care Proxy status is correct and invoke, if appropriate.

DAILY VISITS

• Initiates and reviews orders, including medications, on a daily basis,
• Reviews labs, radiology reports, and consults on all patients.
• Examines and interacts with each assigned skilled-level patient Monday through Friday.
• Writes at least one daily progress note for each assigned patient.
• Assesses each patient’s medical stability daily. Consults coordinates with specialists as needed.
• Addresses acute mental status changes via non-pharmacological or pharmacological measures consultation or transfer.
• Coordinates/assesses rehab progress on a daily basis.
• Discusses concerns with the patient, family, rehab and case management. Educates patient and family members regarding acute and chronic illness management.
• Informs attending and or ACA medical director of significant changes in medical condition.
• Participates in weekly utilization meetings collaborating with the SNF care team and ACA care managers.
• Coordinates with PCP’s, Hospitalists, ACA Medical Directors and Case Managers.
• Addresses/coordinates any legal issues.

DISCHARGE

• Develops a discharge plan utilizing input from case management and rehab. Identifies barriers to discharge.
• Creates detailed discharge summary for each admission on all patients, including medication reconciliation, and sends to the PCP at the time of the SNF discharge.
• Ensures that patients have all appropriate drug and DME prescriptions at discharge.
• Coordinates visits with the PCP post discharge.
• Sends discharge summary to the PCP at discharge.
• Coordinates transition from skilled to long term placement.

Long-Term Care

• Assists case management in the evaluation of selected long-term patients.
• Follows “new” long term patients every 30 days.
• Assists the attending physician with management for complex long-term patients.

Qualifications:

• MSN required.
• Registered Nurse licensed to practice in Virginia or eligible required.
• Current Virginia state certification as an Adult Nurse Practitioner required.
• AHA BLS Provider required at hire.

• Valid DEA certificate required.

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.