Position: Nurse Practitioner
The Monogram Nurse Practitioner will be responsible for the delivery of personalized compassionate medical care to patients primarily with CKD and/or ESRD/ESKD. The Nurse Practitioner will be responsible for caring for patients, maintaining accurate and current patient records and scheduling, and administering follow-up appointments to patients as required. The successful candidate will work as a team with our field-based nurses, community health workers, and physicians and assist in delivering premium care to every patient. Primary duties include patient health assessment, creating strategies to improve or manage a patient health, and introduce habits for health promotion. Generally, nurse practitioners 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
- Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment.
- 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 patients 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
- Active and unrestricted Registered Nurse and Nurse Practitioner license.
- Board certified by ANCC or AANP.
- Current and unrestricted DEA certificate.
- Ability to work without direct supervision and practice autonomously.
- Access to transportation, a valid driver's license, and car insurance.
- Must be proficient with medical instruments and equipment required by the work.
- Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology.
- Ability to communicate effectively, in verbal and written form, with retail and medical partners at various levels, patients, family members, physicians and representatives of the community.
- Sound understanding of all federal and state regulations including HIPAA and OSHA.
- 1 or more years of NP experience preferred.
- Bilingual in Spanish is helpful.
- Managed Care/IPA/Health Plan experience.
- Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home.
- Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care
- Competitive salary
- Comprehensive medical, dental, vision and life insurance
- Flexible paid leave and vacation policy
- 401(k) plan with matching contributions
About Monogram Health
Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monograms innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.
At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.
Our name, Monogram, symbolizes the personalized focus of our services.
While the application of the latest technology and data science is critical to our success, we never lose sight that healthcare is ultimately about trusted individual relationships between healthcare professionals and their patients.
Unfortunately, individuals living with advanced CKD and ESRD are negatively impacted by well entrenched systematic forces such as perverse economic incentives, poor adherence to evidence-based care, and a lack of sensitivity to the negative impacts of social determinants of health.
The 21st Century Cures Act is a seminal piece of legislation designed to shift individuals living with ESRD from FFS Medicare into managed care and reverse decades and decades of sub-optimal outcomes. Monogram was born with a vision to serve health plans and other sponsors of health care and solve for these systemic problems. Our mission is to improve clinical outcomes by predicting the onset of CKD and ESRD, slowing its progression, and reducing hospitalizations, morbidity and mortality.
We are founded and operated by a core group of former government programs health plan executives, including our CEO, Michael Uchrin, a world-renown nephrologist and author of over 200 published pieces of research, Dr. Raymond Hakim, and former US Senator Bill Frist M.D., a retired cardiac surgeon and recognized leader for improving the quality of care provided to human beings across the world.
We welcome all stakeholders in the CKD | ESRD ecosystem to join us in our mission to measurably improve outcomes for individuals living with these conditions.