Job Description

• Provide transitional care management through comprehensive acute and chronic patient care and navigation.
• Assess patient health status and determine appropriate diagnostic/therapeutic needs, document patient information using various formats in the patient and office record.
• Educate patients and families as appropriate for outpatient care, ensure continuity of patient care to include patient confidentiality.
• Assess patient's acute and chronic conditions to coordinate care and connect patients with long-term providers.
• Consult and communicate with physicians, staff, and other members of the healthcare team during regular and on-call hours to facilitate appropriate and comprehensive patient care.
• Flexibility and effective time management are important. The ability to work independently with the support of a physician is critical.
• Act as a positive liaison for the physicians, hospital, office, and community at large.

• Current Texas License or be eligible to obtain.
• Must have graduated from an accredited NP or PA school
• Must be able to communicate effectively in English, both verbally and in writing.
• Must be able to obtain all necessary hospital credentials for all required hospitals

• Meets the licensing and certification requirements set forth by the Texas Board of Medical Examiners for Physician Assistants or Nurses.
• License or certification is preferred before hire and required within 30 days of employment.
• BLS and CPR certifications.
• Must have or be eligible to get DPS and DEA licensure.

• Knowledge in all aspects of primary and preventative care in adult patients.
• Satisfactory completion of all required hospital orientation processes.
• Two years of applicable clinical experience preferred.

• Requires full range body motions, good eye to hand coordination, manual dexterity, able to stand for prolonged periods, and the ability to handle and assist patients.
• Requires ability to work and adapt to stressful situations and ability to do multiple tasks in tense situations in a professional manner. Good critical thinking skills.

• Provide Patient Care: performs comprehensive history and physicals, compiles and interprets patient medical information, formulates a diagnosis and treatment plan, respond to physician, staff and needs via on call-status when applicable.
• Assume On-Call Responsibilities: rotates taking after-hours call with Transition Clinic providers. After-hours call does not require reporting to the office.
• Perform Therapeutic Procedures: perform minor wound care and suture or staple removal in accordance with patient needs.
• Order/Perform Diagnostic Test: order appropriate diagnostic studies based on signs and symptoms and disease processes, interpret results and notify appropriate physician, order or perform appropriate testing, recommend treatment as indicated.
• Maintain Patient Records: accurately record patient progress in medical record, develop, implement and record patient treatment and management plans, provide ongoing assessment of care plans in accordance with the most current and cost-effective methods.
• Provide patient Education and Counseling: provide educational materials and instruct patients regarding their condition, counsel patients regarding issues that could arise, treatment plans, wound care, home care, physical and emotional problems, chronic disease management, health maintenance and rehabilitation
• Consultation for patients: make referrals to appropriate physicians and providers.
• Communicate and participate effectively with physicians, patients, staff and administration: demonstrates positive and effective verbal skills with patients, families and co-workers, serve as a role model and resource, attend and participate in required meetings
• Perform all other tasks/responsibilities as necessary.

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