Advanced Practice Practitioner- Spanish Speaking

About Grace at Home

Grace at Home is an innovative health and care company on a mission to eliminate barriers and to improve care in high-need, urban and rural communities. Grace at Home’s purpose is to every day improve the health and well-being of those who need care the most – in their homes and communities.

Overview:

The Advance Practice Practitioner will provide Home-Based Primary Care in patient homes or Assisted Living communities. They hold a panel of patients and are responsible for diagnosing, treating and managing their acute and chronic medical conditions with MD oversight.

Integral to the primary care team, you will perform annual health assessments, complete post discharge visits, and deliver cost-effective, quality care to assigned patients. Working collaboratively across a multi-disciplinary team, you will contribute to the development, implementation, and on-going refinement of home health processes.

Duties and responsibilities:

Clinical  

• Performing comprehensive in-home assessments for identified patients of the practice and assisting the primary care team in better managing chronic diseases.  
• Reviewing current symptoms and identifying diagnosis to be used in care management and active medical management of treatment.  
• Completing physical examinations, medication reviews, vital checks, lab draws, wound care and depression screenings.  
• Communicating assessment findings that will be used to inform the PCP of potential gaps in care. 
• Provide short term and ongoing home-based care for patients with complex chronic medical conditions. 

Administrative  

Coaching 

• Answering team member questions, helping with team member concerns, and overseeing team member work for quality and guideline compliance.  
• Assisting and supporting market Medical Director/Clinical Leadership in reviewing advance practice providers’ (APP’s) charts for quality assurance and quality improvement purposes and provision of feedback to team members. This is in addition to chart review performed by the advance practice providers’ (APP’s) supervising physician 
• Assisting and supporting market Medical Director/Clinical Leadership in providing virtual and in person consultation with team members during home visits 
• Assisting market Medical Director/Clinical Leadership in providing feedback to APP’s regarding clinical performance and opportunities for improvement 
• Providing encouragement to team members, including communicating team goals and identifying areas for new training or skill checks  
• Actively updating team members on best practices and continuing expectations  
• Assisting market Medical Director/Clinical Leadership in promoting team member achievement of company and market performance goals.
• Program development and management
• Assisting market Medical Director/Clinical Leadership with the planning, organization, direction, and evaluation of health care services provided by the provider team in support of the clinical model.  
• Onboarding / training 
• Assisting Management and medical directors with planning and execution of new team member training on as needed basis.
• Training new team members on clinical processes and programs within individual’s area of expertise. 
• Providing new team members with additional coaching and mentorship during and following onboarding. 

• Providing ongoing education to team members on clinical processes and programs within individual’s area of expertise.
• Utilization management
• Supporting market Medical Director/Clinical Leadership in organization and execution of team case rounds (ex. utilization management case rounds, wound care case rounds 

What will make you successful here? 

• Ability to travel within the market to provide care to patients in their home based on the needs of the business/market.
• Highly relationship oriented and ability to passionately serve the aging and elderly population.  
• Ability to evaluate and treat complex chronic conditions in the home setting 
• Positive attitude with a solution-oriented approach and a comfort working within ambiguity.  
• Ability to receive constructive feedback from other team members, market Medical Director, and Management and address opportunities for improvement. 
• Ability to deliver constructive feedback to team members and discuss improvement opportunities.
• Open minded; willingness to try new ideas, consider different perspectives, and adapt to change. 
• Ability to make decisions and create solutions that consider patient, team member, and business needs.  
  

What will define success in this role? 

Be a clinical leader and work with all providers to: 

• Accuracy on risk capture, high quality metrics, gap closure rates, and HEDIS exclusion diagnoses.   
• High patient satisfaction and improved health status including reduced hospitalization and emergency department visits. 
• Thinking critically to address patient needs, providing the appropriate resources and follow-up care to improve stability.  

• Educating patients on topics such as disease process, medication, and compliance  
• Complying with all HIPAA regulations and maintaining security of protected health information.  
• Creating a positive, supportive, trusting team environment.  
• Effectively onboard new hires so they can provide care independently in the home 
• Contribute to program development that ensures team success in reaching performance goals.

Qualifications

• Education:
  • Family Nurse Practitioner (FNP), Adult Nurse Practitioner with geriatric experience, Advance Practice Registered Nurse (APRN), or Physician Assistant (PA).  
  • Certification & Licensure: Board certified (American Association of Nurse Practitioners [AANP] or American Nurses Credentialing Center [ANCC]) and holds active state licensure in the state of practice.
• Experience:
  • 3+ years of clinical experience as an APRN / FNP / PA in the primary care or home care setting.  
  • Working knowledge of chronic care management and various medication options 
  • Current DEA license/Prescriptive Authority post-hire in NY. 
  • Experience in Family Medicine, Internal Medicine, Geriatrics, Palliative Care, or home care.  
• Communication: Bilingual, Spanish & English required.

Benefits:

Financial Well-being

• Competitive Compensation: We offer competitive salaries to attract and retain the best talent.
• 401(k) with Employer Match: Plan for your future with our 401(k) plan and a generous 4% employer match.

Health and Wellness

• Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
• Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
• Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
• Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.

Additional Perks

• Continuing Medical Education (CME) Allowance for Providers: Stay at the forefront of your field with our CME allowance.
• Commuter Benefits: Save on your commute with our commuter benefits program.
• Mileage Reimbursement: Get reimbursed for work-related travel expenses.

The working environment and physical requirements of the job include:

This position requires in-home, assisted living, and independent-living community-based work. The job requires frequent travel for patient visits in all types of weather conditions. Work may be performed in settings with conditioned air, artificial light, and an open workspace.

In this position you will need an ability to travel frequently by car and/or public transportation, the ability to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting or standing for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 50 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.

Equal Opportunity & Reasonable Accommodation Statement

Grace at Home is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.

If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process.