Nurse Practitioner in San Marcos, California at Palomar Health Palliative & Hospice

Schedule: PRN

Compensation: Starting compensation range of $95.00 hourly. Exact compensation will be determined by experience, education, licensure/certifications, and location, in accordance with applicable laws.

Benefits:

• Comprehensive medical, dental, and vision insurance package (full-time)
• 401(k) retirement plan
• Assistance with licensure renewal
• Generous PTO policy
• The opportunity to build from the ground up and put your stamp on a growth-stage organization!

Position Overview:

The Hospice Nurse Practitioner (NP) is an advanced practice clinician and a cornerstone of Loma Linda University Hospice’s clinical model, providing expert medical oversight, comprehensive patient assessments, and hospice certification and recertification services across home, facility, and hospital-based care settings. Working in close collaboration with the Medical Director, attending physicians, and the interdisciplinary team (IDT), the NP ensures that every patient’s eligibility is thoroughly documented, their comfort needs are expertly managed, and their goals of care are honored at every stage.

This role sits at the intersection of clinical excellence, regulatory compliance, and patient-centered care. The Hospice NP is accountable for the accuracy of eligibility determinations, the clinical integrity of certification documentation, and the quality of advanced symptom management — all while serving as a trusted clinical partner to patients, families, physicians, and the care team.

This role demands strong clinical judgment, deep knowledge of hospice eligibility criteria and Medicare regulations, and the emotional intelligence to lead complex goals-of-care conversations with compassion and clarity. Hospice NPs are expected to operate with full ownership of their patient panel, a high degree of autonomy, and an unwavering commitment to clinical excellence.

Responsibilities:

Hospice Eligibility Assessments

• Conduct comprehensive face-to-face (F2F) clinical assessments to evaluate and document hospice eligibility in accordance with Medicare Conditions of Participation and CMS LCD guidelines for each applicable diagnosis
• Review and synthesize referral documentation, medical records, diagnostics, functional assessments, and physician notes to support and substantiate eligibility determinations
• Perform thorough clinical evaluations of prognosis, disease trajectory, functional decline, and symptom burden using validated tools including PPS, FAST, NYHA, BODE, and MMSE as clinically indicated
• Clearly document the clinical rationale supporting a limited life expectancy of six months or less in the EMR, ensuring documentation withstands audit scrutiny
• Collaborate with the Medical Director and attending physicians to align on prognosis and confirm appropriateness for the hospice benefit
• Identify and communicate cases that may require additional physician review, alternative level-of-care consideration, or palliative care consultation

Hospice Certifications & Recertifications

• Complete all initial hospice certifications in compliance with Medicare requirements, ensuring physician co-signature and timely execution of election documentation
• Conduct recertification evaluations at the 90-day and subsequent 60-day benefit periods, performing and documenting the required face-to-face encounter for patients approaching their third and subsequent benefit periods per 42 CFR §418.22
• Document a detailed narrative in each recertification that reflects the patient’s current clinical status, functional decline, symptom progression, and continued eligibility — going beyond templated language to provide individualized, audit-ready documentation
• Proactively manage recertification timelines to prevent lapses in benefit coverage, coordinating with the IDT, case managers, and intake team to ensure no patient falls through the cracks
• Review and reconcile Plans of Care (POCs) at each certification period, updating goals, interventions, and expected outcomes in collaboration with the IDT
• Identify patients whose clinical trajectory may no longer support continued hospice eligibility and communicate findings to the Medical Director and IDT with appropriate urgency and sensitivity

Advanced Clinical Care & Symptom Management

• Provide advanced symptom management for complex or refractory pain, dyspnea, agitation, nausea, and other end-of-life symptoms, including initiating and adjusting controlled substance regimens within NP scope of practice
• Conduct urgent and non-urgent patient visits to assess acute changes in condition, adjust the plan of care, and support the family through critical transitions
• Order and interpret diagnostic studies, medications, and treatments as clinically appropriate and consistent with the hospice benefit and comfort-focused goals of care
• Prescribe and manage comfort kit medications, ensuring patients and families are educated on appropriate use and that formulary compliance is maintained
• Provide clinical consultation to RNs, LVNs, and aides on complex patient cases, serving as an advanced clinical resource for the field team
• Support continuous care (CHC) and general inpatient (GIP) level-of-care determinations and document the clinical criteria supporting each level of care

Goals of Care & Family Communication

• Lead or co-facilitate goals-of-care conversations with patients, families, and referring providers, translating complex clinical information into compassionate, culturally sensitive guidance
• Support informed consent conversations related to the hospice election, treatment limitations, and advance care planning (ACP) in alignment with the patient’s values and wishes
• Engage families during critical transitions including the active dying phase, providing presence, education, and emotional support alongside the social worker and chaplain
• Serve as a clinical liaison between the hospice IDT and attending physicians or specialists, communicating changes in condition, eligibility status, and care plan updates clearly and promptly

IDT Collaboration & Medical Director Support

• Participate actively in IDG/IDT meetings, providing advanced clinical input on assigned patients and contributing to care plan development and revision
• Support the Medical Director in managing physician order requests, urgent clinical consultations, and regulatory documentation requirements
• Collaborate with admissions nurses on complex referrals requiring advanced eligibility evaluation prior to admission
• Contribute to clinical education for the IDT on disease progression, symptom management, and end-of-life care best practices

Documentation, Compliance & Quality

• Ensure all assessments, certifications, recertifications, and visit notes are completed accurately, thoroughly, and on the day of service in the EMR
• Maintain full compliance with Medicare Hospice Conditions of Participation, CMS documentation requirements, and applicable state and federal regulations
• Participate in chart audits, QAPI initiatives, and clinical quality improvement projects as directed
• Adhere to HIPAA and organizational confidentiality standards at all times
• Maintain active DEA registration and comply with all state and federal controlled substance prescribing requirements

Performs other job-related duties as assigned.

Performance Outcomes & Key Metrics

Clinical Quality & Compliance (40%)

• Accurate hospice eligibility determinations with individualized, audit-ready documentation
• Timely completion of certifications and recertifications — zero lapses in benefit periods
• Chart audit and documentation compliance = 99%; zero material deficiencies
• Appropriate and proactive escalation of complex cases to the Medical Director

Patient, Family & Partner Experience (30%)

• High patient and family satisfaction with NP interactions and goals-of-care communication
• Positive feedback from IDT members, physicians, and referral partners
• Demonstrated clinical credibility, empathy, and responsiveness at every interaction

Operational Accountability (20%)

• Proactive management of recertification schedules — no missed or late benefit periods
• Timely completion of F2F documentation required for billing and compliance
• Effective coordination with admissions, case management, and the Medical Director

Culture & Team Contribution (10%)

• Consistent demonstration of clinical leadership, accountability, and emotional intelligence
• Active contribution to IDT education and continuous quality improvement
• Participation in training, skills development, and organizational growth initiatives

• Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) from an accredited program, with completion of an NP specialty track — Family (FNP), Adult-Gerontology Primary Care (AGPCNP), or Adult-Gerontology Acute Care (AGACNP) preferred
• Active, unrestricted Nurse Practitioner license in the State of California
• Current Furnishing Number issued by the California Board of Registered Nursing (BRN)
• Active DEA registration with current controlled substance prescribing authority
• Minimum 2 years of clinical experience as an NP; hospice, palliative care, geriatrics, or oncology experience strongly preferred
• Strong working knowledge of Medicare Hospice Conditions of Participation, CMS LCD criteria, and hospice certification and recertification requirements
• Demonstrated proficiency in conducting and documenting F2F assessments, hospice certifications, and recertifications
• Exceptional clinical judgment, communication, and interpersonal skills
• Proficiency with EMRs and clinical documentation systems (Devero or similar preferred)
• Valid California driver’s license, reliable personal vehicle, and proof of current auto insurance

Preferred:

• Prior hospice or palliative care NP experience with direct experience in eligibility assessments and Medicare recertification
• ACHPN (Advanced Certified Hospice and Palliative Nurse) certification, or in progress
• Experience working in hospital-based, SNF, or joint venture hospice models
• Familiarity with prognostic tools including PPS, FAST, NYHA, BODE Index, and MMSE
• Bilingual English/Spanish — highly valued for serving our diverse patient population
• Experience supporting or collaborating with a hospice Medical Director on complex clinical and compliance matters

Cultural competencies

Hospice Nurse Practitioners are expected to:

• Take full ownership of outcomes — every assessment, every certification, and every patient conversation matters
• Operate with clinical urgency while maintaining the compassion and presence this work demands
• Communicate clearly, directly, and respectfully with patients, families, physicians, and all team members
• Uphold the highest standards of clinical integrity, regulatory accountability, and ethical practice
• Serve as a trusted clinical leader and representative of the organization's mission and values at all times

Work Environment & Physical Requirements (if applicable)

• Ability to perform job duties across a variety of settings, including patient homes, assisted living communities, skilled nursing facilities, and inpatient environments.
• Regular standing, walking, and driving between patient visits or work locations.
• Frequent bending, stooping, kneeling, and reaching while providing care or completing assessments.
• Ability to lift or assist with moving patients and equipment up to 50 pounds, with or without reasonable accommodation; additional support or equipment may be used for heavier transfers.
• Sufficient hand dexterity to complete clinical tasks such as administering medications, documenting in electronic systems, and using medical equipment.
• Visual and hearing ability to safely assess patients and communicate clearly with patients, families, and team members.
• Ability to respond appropriately in urgent or emergency situations, including performing CPR if required.
• Comfort working in a range of home environments, including exposure to pets, smoke, and varying indoor/outdoor conditions.
• Regular use of computers, tablets, and mobile devices for documentation, communication, and virtual meetings; ability to sit for extended periods while completing electronic charting and administrative tasks.
• Reliable transportation and ability to travel within the service area.
• Ability to manage the physical and emotional aspects of working in end-of-life care.

About Palomar Health Palliative & Hospice

Palomar Health Palliative & Hospice is dedicated to a patient-first mission, ensuring compassionate, high-quality care that supports patients and families through every stage of need. Our culture is defined by data-driven excellence, operational transparency, and a steadfast commitment to its core values of Dignity, Integrity, Compassion, Excellence and Partnership. With an expanding network through partnerships, Palomar Health Palliative & Hospice is positioned for continued growth and innovation as it scales to new markets.

Palomar Health Palliative & Hospice is an equal opportunity employer and is committed to a policy of equal employment opportunity for all employees and applicants. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status in accordance with applicable federal, state, and local laws. All employment decisions are based on job requirements, individual merit, and business needs.