Nurse Pract Palliative

Clinical Patient Care Management

• Provides palliative care for residents in their home or clinical setting in collaboration with physicians and/or medical directors in conformance with any protocols or guidelines established by or with the collaborating physician, where required by state and/or federal law.
• Performs medically necessary assessments meeting the requirements of Medicare Part B, Evaluation and Management (E&M) codes with accurately and timely documentation.
• Schedules all visits based upon medical assessment and/or the established individualized care plan for the patient.
• Orders and reviews appropriate treatments, lab, x-rays, EKGs, and other diagnostic procedures as indicated by a palliative plan of care and documents the treatment plan accordingly.
• Reviews results with collaborating physician if recommendations for treatment are required. When clinically appropriate, re-schedules another visit to follow-up on abnormal labs or test results.
• Reviews, signs, and dates consultation notes, adjusts in the treatment plan accordingly, and notifies collaborating physician.
• Collaborates with the physician, referring physicians and other healthcare professionals to ensure optimal delivery of patient care.
• Collaboration and coordination of care with referral sources including hospitals, assisted living facilities, nursing homes, group homes and primary care providers and specialists.
• Collaboration with business development, hospice and home health business units.
• Working with business development in the community to promote palliative education to appropriate stakeholders.

Home Visit-specific Standards

• Conducts medical visits, as frequently as dictated by medical condition or by the established individualized care plan for the patient.
• Contacts collaborating physician or Medical Director if treatment of patient's condition warrants physician intervention or needs significant change in treatment plan.
• To the extent requested, provides the physician and referral sources with copies of the progress notes, test results and medication changes.
• Provides communication and education about disease trajectory and treatment plan to patient and family.
• Leaves business card and appointment card with patient and family and instructs on how to contact the nurse practitioner.

Medical Record Documentation

• Always completes all medical record documentation promptly and in compliance with any applicable state and federal laws and regulations.
• Communication
• Educates patient and family about conditions or instances where Nurse Practitioner needs to be called.
• Informs patient and family of how to contact him or her.
• Promptly returns all calls.
• Communicates with collaborating physician and healthcare team.
• Establishes a frequency of communication standard with collaborating physician and healthcare team pursuant to patient needs and in conformity with state and federal requirements.
• Notifies collaborating physician of any significant medical issues relating to patient care or patient's condition.
• Meets with collaborating physician for chart review and quality improvement as required by applicable state law. Communicates and documents any other state or federally required communication and documentation, which may include review of the collaborating agreement and review and/or documentation of prescriptions ordered by the NP.

Medical Compliance and HIPAA Guidelines

• Documents in medical record other individuals with whom the patient consents to the discussion of their medical treatment.
• Maintains all standards of compliance as outlined in the Company's compliance plan.
• Notifies the Compliance Officer immediately, if NP identifies or suspects any infringements of Medicare, state and/or federal laws or regulations.
• Complies with policies, procedures and regulatory mandates including but not limited to abiding to the terms of the Amedisys Compliance Program.
• Performs other duties as assigned.