Advanced Practice Provider - Chronic Disease Management
Summary of Essential Functions
Provides comprehensive acute and chronic patient care across inpatient setting
Independently evaluates and manages patients within APP scope of practice
Assesses patient health status and determines diagnostic and therapeutic needs
Documents patient information accurately within the medical record
Educates patients and families to support continuity of care
Collaborates with physicians and interdisciplinary teams
Acts as a liaison between providers, hospital, and community
Work between the hours of 7a and 7p with weekend/holiday rotation
Educational Requirements
Graduate of an accredited Nurse Practitioner or Physician Assistant program
Meets Texas requirements for Advanced Practice Nurses or Physician Assistant
Licenses and Certifications
Current Texas Licensure Nurse Practitioner or Physician Assistant (PA)
Eligible to obtain prescriptive authority (DEA/DPS as applicable)
National certification as and Advanced Practice Nurse or Physician Assistant
ACLS/PALS preferred
Knowledge/Skills/Abilities
Clinical experience preferred
Experience in palliative care, hospice, internal medicine, hospital medicine, endocrinology or critical care preferred
Strong critical thinking skills
Completion of hospital orientation requirements
Excellent verbal and written communication skills
Commitment to patient-centered, compassionate care
Physical Requirements
Ability to stand for extended periods and perform clinical tasks
Ability to lift up to 50 pounds
Ability to work in high-stress environments
Exposure to bloodborne pathogens
Duties and Responsibilities
Conduct comprehensive patient assessments, including medical history, physical examination, and review of diagnostic data to guide clinical decision-making
Develop, implement, and adjust individualized, evidence-based care plans in collaboration with the interdisciplinary team and supervising physician as required
Maintain compliance with applicable Texas Medical Board and Texas Board of Nursing supervision/collaborative agreements and regulatory requirements including periodic face-to-face meetings with supervision physician and documentation of chart review as required
Provide education to patients, families and interdisciplinary team members on disease management, symptom control and goals of care.
Document all patients encounters accurately and timely in the electronic medical record (e.g., EPIC), ensuring compliance with regulatory and organizational standards
Collaborate with physicians, nursing staff, case management, social work, and other disciplines- and participate in interdisciplinary rounds as needed- to ensure coordinated, patient-centered care
Perform palliative care consultations for patients with life-limiting illnesses
Lead and support goals-of-care discussions, including advance care planning and code status clarification
Assess and manage complex symptom burden
Deliver compassionate, comfort-focused care for patients designated as comfort care, ensuring symptom relief, dignity, and alignment with established goals of care
Participate in quality improvement initiatives focused on clinical outcomes, patient experiences and cost-effective care
Provide emotional support to patients and families
Coordinate care with hospice and community palliative resources
Manage inpatient diabetes care, including glycemic control and insulin titration
Utilize decision support clinical tools (e.g., Endo Tool) to support insulin management
Collaborate with nursing on insulin and glucose monitoring practices
Identify and address barriers to glycemic control
Coordinate discharge planning and outpatient referrals
Facilitate transitions of care, including appropriate referrals and communication with outpatient providers
Participate in interdisciplinary rounds and discharge planning
Identify high-risk patients and implement interventions
Provide staff education and support when needed
Participate in program development and workflow improvement
Serve as a clinical resource and mentor
Contribute to quality improvement initiatives and monitor key metrics
Maintain licensure and certifications
Adhe
Numbers & Facts
Location
Wichita Falls, Texas
Skills
Advanced Cardiac Life Support (ACLS)unmatched
Advanced Practice Nurse (APN)unmatched
Certified Case Manager (CCM)unmatched
Chronic Diseaseunmatched
Clinical Dataunmatched
Clinical Medicineunmatched
Clinical Outcomesunmatched
Clinical Supportunmatched
Communication Skillsunmatched
Critical Careunmatched
Decision Supportunmatched
Diabetesunmatched
Discharge Plansunmatched
Disease Prevention and Controlunmatched
Documentationunmatched
Electronic Medical Recordsunmatched
Endocrinologyunmatched
Epic Systemsunmatched
Health Planunmatched
Hospice Careunmatched
Hospitalunmatched
Insulinunmatched
Internal Medicineunmatched
Lift/Move 50 Poundsunmatched
Maintain Complianceunmatched
Medical Recordsunmatched
Medicineunmatched
Mentoringunmatched
Metricsunmatched
Needs Assessmentunmatched
Nurse Practitionerunmatched
Nursingunmatched
Nursing Credentialsunmatched
Nursing Managementunmatched
Outpatient Careunmatched
Palliative Careunmatched
Pathogensunmatched
Patient Assessmentunmatched
Patient Careunmatched
Patient Educationunmatched
Pediatric Advanced Life Support (PALS)unmatched
People Managementunmatched
Physical Demandsunmatched
Physician Assistantunmatched
Presentation/Verbal Skillsunmatched
Quality Assuranceunmatched
Quality Managementunmatched
Quality of Careunmatched
Regulatory Complianceunmatched
Regulatory Requirementsunmatched
Risk Analysisunmatched
Set Goalsunmatched
Social Workunmatched
Staff Trainingunmatched
Team Playerunmatched
Time Managementunmatched
Titrationunmatched
Training/Teachingunmatched
Writing Skillsunmatched
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