Nurse Practitioner

In collaboration with the physician, provides and coordinates primary preventive care, emphasizing functional independence and treating a member’s physical, social and psychological needs. Insures development of plan of care and access to services in accordance with the goals and objectives by communicating and collaborating with the interdisciplinary team including the nursing home administrative staff. Essential Functions Performs routine, monthly clinical assessments on all Archcare Advantage members which reflects an understanding of the complexity and multiple co morbidities of the frail and/ or elderly Archcare Advantage member. Assesses and manages members with acute change in condition in a timely manner. Assesses members upon return from the hospital within 24 hours (or next business day). Reconciles medications and treatment plans. Upon notification or identification of change in condition, assesses and determines the need for skilled services benefit based on Archcare Advantage policy. Submits Superbills on all Archcare Advantage members with ICD 9 codes reflective of documentation in the medical record and appropriate to the member’s disease complexity. Initiates and/or participates in advance care plan discussions with the Archcare Advantage member, the members family and the interdisciplinary team in the nursing facility. Documents the discussion and outcome in the medical record. Reviews the advance care plan at least quarterly and when there is an acute change or a decline in member status. Communicates with the Archcare Advantage members designated representative regarding the members status each month and when there is an acute change or a decline in the members status. Manages care transitions. Communicates with appropriate hospital personnel when the Archcare Advantage member is transferred to the hospital. Reports hospitalizations to the Archcare Advantage team in a timely manner Attends and participates in Archcare Advantage team meetings. Communicates with the Archcare Advantage team as requested and in accordance with Archcare Advantage policies and procedures. Maintains a collaborative agreement with an Archcare physician. Ensures that 10 – 15% of charts are reviewed quarterly. Collaborates with the Archcare Advantage members attending physician at least quarterly and when member’s status warrants. Documents discussion in medical record. Participates in interdisciplinary team meetings regarding the Archcare Advantage member. * Serves as educational resource for nursing facility staff, Archcare Advantage members and their families, and Archcare Advantage staff. NYS NP licenseDEA registrationNursing home and/or managed care experience preferred

Work location: Rhinebeck, NY