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Home Visit APRN/PA - Henry and Glades County in Moore Haven, Florida at M&H

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M&H
Moore Haven, Florida, 33471, United States
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Job Description

Job Summary:

As a “Home Visit APRN or PA” you will function as a day-to-day clinical leader, providing support and care during patient transitions from acute to home: directing the multidisciplinary team.

Primary Functions:

  • Perform 6-8 preventive visits daily to optimize chronic conditions, assess home environment, educate patients and caregivers, and develop proactive care plans.
  • Perform timely new care visits and follow up care as needed in the home, while our focus is to avoid unnecessary ED transfers and hospital admissions.
  • In situations where there is no existing PCP for the patient, assume responsibility as interim provider and drive care and continuity for patients.
  • In situations where there is an existing PCP for the patient, help to co-manage the patient with the PCP and serve as an extension of clinical care into the home.
  • Coordinate with other physicians across the continuum of care, including PCP, hospitalist, and SNF providers to smooth transitions and prevent readmissions.
  • Coordinate and offer medical direction to community-based organizations touching the lives of our patients, including housing and caregiver agencies, health plan contracted social work services, home health, adult day health centers, and behavioral health.


    • Education, Training, Experience:

  • Active FL medical license in good standing


    • Job Location

    Moore Haven, Florida, 33471, United States

    Frequently asked questions about this position

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