Join Hospice of Michigan - EverCare Program. We're seeking a compassionate, experienced Nurse Practitioner who enjoys caring for medically complex older adults and thrives in a collaborative, team-based environment. Experience in primary care, home-based care, geriatric medicine, assisted living, skilled nursing, or palliative care is highly desirable. All full-time and eligible part-time employees would have the following benefits: Health, Dental, and Vision insurance Paid parental leave Flexible spending account Health savings account Life insurance Tuition reimbursement Pet insurance Generous paid time off 403(b) retirement savings with company match What You'll Do Serves as the primary clinician for an assigned panel of geriatric patients, providing longitudinal primary care in office, home, assisted living, and skilled nursing settings as assigned. Completes and documents accurate, comprehensive histories and physical examinations; provides diagnosis and treatment of acute and chronic conditions, including ordering and interpreting diagnostic tests and prescribing medications and treatments according to the collaborative practice agreement and NP scope of practice laws, as approved by the Medical Director. Performs comprehensive geriatric assessments addressing chronic disease burden, functional status, cognition, mobility and fall risk, sensory impairment, nutrition, continence, mood, polypharmacy, caregiver capacity, and social determinants of health. Conducts Annual Wellness Visits (AWVs), Initial Preventive Physical Exams (IPPEs), and comprehensive visits that support accurate and complete documentation of all active diagnoses to the highest level of specificity, supporting risk adjustment data integrity and appropriate care planning. Performs proactive medication management for older adults, including deprescribing of potentially inappropriate medications, simplification of regimens, and medication reconciliation at every encounter and following all transitions of care. Manages acute changes in condition with a treat-in-place approach whenever clinically appropriate, including urgent visits, telehealth assessment, and after-hours telephone management, to prevent avoidable emergency department visits and hospitalizations. Leads timely post-discharge care following hospital, emergency department, and skilled nursing facility stays, including Transitional Care Management (TCM) visits within required timeframes, in coordination with the EverCare RN. Provides and documents advance care planning, goals-of-care, and end-of-life discussions with patients, families, and legal representatives; completes and maintains advance directives and

POST/POLST

documentation; coordinates timely referral to palliative care and hospice services when appropriate and requested. Establishes and updates individualized, patient-centered care plans in collaboration with the EverCare RN, and provides clinical direction for the RN's chronic care management activities, including reviewing escalations, co-signing care plans as required, and prioritizing outreach for high-risk patients. Qualifications Current Nurse Practitioner license with national certification (AGPCNP, FNP, Adult-Gerontology NP, or equivalent) and current DEA registration. At least one year of Nurse Practitioner experience (or equivalent advanced clinical experience). Master's degree or Doctorate in Nursing with advanced skills in physical assessment. Experience in primary care, geriatrics, home-based primary care, assisted living, skilled nursing, or palliative care strongly preferred.

Work Location:

In person