Under general supervision, accountable for the palliative clinical management(to include, but not limited to symptom management, advance care planning, and counseling and supportive services), as well as the care coordination of those patients living with serious illness and who are becoming increasingly limited in their ability to perform personal activities of daily living, independently, in the community-based setting. The community-based setting includes patients' homes, private residences, senior living communities and skilled nursing facilities.
Education
Successful completion of a Certified Nurse Practitioner program
Experience
At least five (5) years of related experience in a healthcare environment.
At least one (1) year of Geriatric or Palliative NP experience at patients' home, within skilled rehab, long term care or assisted living settings)
At least one (1) year of Home Care or Hospice / Palliative Care.
Knowledge, Skills and Abilities
- Skill in using computer, familiarity with the use of electronic medical records
- Effective written and oral communication skills to communicate and relate effectively with patients, family, staff, other home-based providers, the public, physicians, referring and partner health systems and practices and insurers.
- Skill in effectively collaborating with a wide variety of service providers who also are working with the patient and with the CBPC team members.
- Skill in effectively working with patient / family with challenging psycho-social, and socio-economic issues and circumstances.
- Analytical skills in order to assess patients and implement appropriate intervention, care plans, and treatments
- Able to work under varying degrees of stress and the ability to adjust to changes in the work environment.
Licensures, Certifications
Current registration with the Maryland State Board of Examiners of Nurses as a Nurse Practitioner, specializing in Adult, Family or GeriatricsCurrent CPR certificationHospice and Palliative Care Certified is preferredPrincipal Duties and Responsibilities
Assumes Consultant responsibility for the initial evaluation and treatment of patients in assigned areas.Performs initial history and physical as evidenced by appropriate documentation, including medication reconciliationReviews, Instructs and Completes Advanced Care Planning with patient and / or families with initial meeting and subsequent visits, as needed and indicated.Writes appropriate orders related to newly diagnosed and pre-existing conditions, in coordination with the primary care provider and / or specialists involved with care.If acting in a consultative role, discusses with the referring and / or attending physician, as appropriate, physical and / or emotional findings, which may interfere with care of the patient.Ensures review, consent for, and enrollment in the chronic care management program as appropriate.Communicates findings with HBPC team and coordinates plan of careEvaluates patient progress on a continuing basis and in collaboration with the referring physician, as appropriate and alters treatment modalities as needed.Evaluates nursing, medical, social and educational needs on assigned patients.Initiates referral to appropriate community resources based on patient need and documents on the progress note.Writes / Types progress notes for each visit documenting pertinent information regarding patient progress and treatment regime.Writes orders appropriate to the patient's care requirements in compliance with existing contract.Establishes medical diagnoses in compliance with contract.Refers to the physician or designee, as appropriate those problems which require consultation and documents same on progress note.Makes immediate referral of acute and or life threatening patient conditions to emergency department or hospice as appropriate per patient care plan. Documents physical findings and treatment plan pertaining to same.Uses electronic health record system to document all activities with the patient and family.Performs technical functions as covered by the job description, in accordance with GBMC policy.Documents results of technical functions performed.Reportsto physician or designee, as appropriate any abnormal findings related to it when appropriate and if indicated.Monitors patient response related to technical function performed and documents it.Acts as a clinical resource.Actively supports and participates in departmental performance improvement initiatives.Actively participates in Gilchrist / Palliative Medicine meetings and conference calls and in group functions, including an equitable share of on-call responsibilities, attendance at meetings and periodic planning activitiesPerforms activities to meet patient / family educational needs.Participates actively in health teaching of patient and family to include preventative health care as well as current medical condition and treatment regime. Evidence of same by documentation on progress note and / or established flow sheet.Review discharge planning with patients and their families, as appropriate.Reviews and updates MOLST form and goals of care with patient, and / or POA and referring physician when indicated and as needed.Assumes responsibility for utilizing opportunities for educational advancement by pursuing activities to meet identified educational needs and those required for continue certification as well as attending mandatory in-service as required by department and GBMC.Acts a liaison for the GGL group to our Community partners, our hospital partners, and our governmental partners. Works in conjunction with the GGL Leadership team and Palliative Medicine Section Chief / Director to report issues and concerns and assists with resolution of those issues whenappropriate.
Physical Requirements
Patient care environment includes patient residence to include, but not limited to private home, Assisted Living Facilities (ALF) and Continuing Care Residential Communities (CCRC).May have exposure to communicable disease or infectious diseases as well as adverse working conditions due to certain patient dwellings, weather conditions and driving conditionsMay have exposure to communicable disease or infectious diseasesMay have responsibility for a large geographic territoryMay be required to work in settings that do not have internet connectivityWorking Conditions
Maintain current licensure as an RN / Nurse Practitioner.Must maintain productivity and quality standards as set by Gilchrist.Must have own reliable transportation.Conditions of Employment
CAPC Designation completion; able to complete during first 90- days of onboarding with the OrganizationAll roles must demonstrate GBMC Values
GBMC Values
Value Description
Respect
I will treat everyone with courtesy. I will foster a healing environment.
Treats others with fairness, kindness, and respect for personal dignity and privacyListens and responds appropriately to others' needs, feelings, and capabilitiesExcellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
Meets and / or exceeds customer expectationsActively pursues learning and self-developmentPays attention to detail; follows throughAccountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
Sets a positive, professional example for othersTakes ownership of problems and does what is needed to solve themAppropriately plans and utilizes required resources for various job dutiesReports to work regularly and on timeTeamwork
I will be engaged and collaborative. I will keep people informed.
Works cooperatively and collaboratively with others for the success of the teamAddresses and resolves conflict in a positive waySeeks out the ideas of others to reach the best solutionsAcknowledges and celebrates the contribution of othersEthical Behavior
I will always act with honesty and integrity. I will protect the patient.
Demonstrates honesty, integrity and good judgmentRespects the cultural, psychosocial, and spiritual needs of patients / families / coworkersResults
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
Embraces change and improvement in the work environmentContinuously seeks to improve the quality of products / servicesDisplays flexibility in dealing with new situations or obstaclesAchieves results on time by focusing on priorities and manages time efficientlyPay Range
$80,363.74 - $133,809.65
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
COVID-19 Vaccination
All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
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