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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:

Obtain, record, and dictate medical histories and physical examinations.   Make daily rounds, record progress notes, write routine orders (comfort and diet, laboratory tests, non-invasive examinations, etc.). Perform 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. Request consults from appropriate physicians. Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections, and injuries. Prescribing medications and other treatments. Managing patients' overall care.

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
• Review approve and modify admission orders
• Create a 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/assess 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. Identify barriers to discharge.
• Create a 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.
• Coordinate visits with the PCP post discharge.
• Discharges summery be sent 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:

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