Field Nurse Practitioner

Position : Field Advanced Practice Provider

The Monogram Advanced Practice Provider is a Nurse Practitioner is a critical role that provides access to comprehensive care to underserved patients within their assigned territory. The Advanced Practice Provider will be responsible for delivery of personalized compassionate medical care to patients primarily with CKD through ESRD. The Advanced Practice Provider will be responsible for caring for patients, maintaining accurate patient records and scheduling and administering follow-up appointments to patients as required across multiple markets. The successful candidate will work as a team with our field-based nurses, community health workers, and physicians to assist in delivering premium care to every patient. Primary duties include patient health assessment, creating strategies to improve or manage a patient's health, and introducing habits for health promotion. Advanced Practice Providers perform the important task of educating patients about preventative care and prescribed treatments. He / she may also conduct physicals, order tests, prescribe medications, and serve as a coordinator with the patient's primary healthcare provider and their specialists.

Roles and Responsibilities

• Travels throughout assigned territory to conduct home conducts in-home assessments, which include comprehensive annual wellness exams, focused screenings, or other visits both in the patients' home and in the virtual environment
• Ability to travel out of state for up to 2-weeks at a time as necessary
• Counsels and educates patients and families about benefits and programs available to help them live healthier lives
• Documents items such as : appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan
• Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services
• Completes all documentation and paperwork in a timely manner
• Maintains quality of care standards as defined by the practice
• This position will not be office-based but will be remote in state in which employed and will need to attend periodic training / meetings outside of that state
• Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first
• Prescribe medications, order tests, and collaborate with patient’s Monogram physician
• Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily
• Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing
• Assists patients with enrolling to access educational videos
• Participates in the integrated care team meetings
• Knowledge of disease diagnosis and prevention
• Make assessment of patient's health status
• Develop treatment plan
• Implement a plan consistent with appropriate plan of care
• Follow-up and evaluate patient's status
• Other duties as assigned

Position Requirements

Benefits

About Monogram Health :

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.