Nurse Practitioner - Advanced Heart Failure /Mechanical Circulatory Support

60% Inpatient - Direct Patient Care (may include some or all of the responsibilities listed)

1.1.       Independently (independent APP encounter) or collaboratively (shared physician and APP encounter) evaluates and manages patients.

1. Includes taking histories, performing physical examinations, responding to changes in patient status, performing consults, ordering or furnishing medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
2. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.
3. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.
4. APPs must respond to clinical documentation integrity inquiries from the Department of Quality and Patient Safety within 3 days.

1.2. Performs procedures granted to them via privileges/standardized procedures.

1.3. Identifies patients with acute decompensation or failure and responds to the hospital plan of care and reviews with physician.

1.4. Initiates consultations as indicated.

1.5. Documents independent assessment findings and recommends appropriate treatments.

1.6. Participates in service rounds and patient evaluation and treatment planning. 

1.7. Reviews lab tests, x-rays, and other diagnostic tests, and initiates appropriate team plans.

1.8. Evaluates complex cases, establishes individualized plans of care for disposition to a lower level of care.

1.9. Interprets and acts upon completed tests, procedures, and radiographic studies.

1.10. Completes clinically relevant paperwork/electronic health record (EHR) documentation, including but not limited to ordering medications, completing episodic care notes and discharge summaries in accordance with the UCSF Rules and Regulations.

1.11. Effectively communicates findings, treatment options, and care plans with patients and their families 

1.12. May first assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.13. Monitors and evaluates patients for discharge. Sets parameters and guidelines for continuum of care with multi-disciplinary team. This includes evaluating and defining discharge regimen.

1.14. Discharges patients including prescribing/furnishing medications, ordering DME, and recommending or referring for ongoing follow up care, providing discharge teaching, and completing discharge summaries.

25% Inpatient – Care Coordination (may include some or all of the responsibilities listed)

1.1. Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning.

1.2. Coordinates episodic care and determines timing of routine clinic follow up.

1.3. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.

1.4. Consults with nursing staff on plan and implementation of individualized nursing care plans. 

1.5. Independently provides case summaries for disability, insurance agencies, workers compensation, work releases, and medical supply agencies.

1.6. Formulates and implements protocols to improve quality and efficiency and control waste in the clinical specialty.

10% Outpatient – Independent Encounters (may include some or all of the responsibilities listed)                

1.1.       Evaluates and manages patients in independent APP encounters, including telehealth.

1. Includes providing care to new, follow-up, acute, routine, and specialty patients.
2. Includes taking histories, performing physical examinations, interpreting diagnostic tests, formulating evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
3. Reviews or collaborates with attending physician as needed.
4. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.
5. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.

1.2. Performs procedures individually granted to them via standardized procedures/privileges.

1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate. 

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.

1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

0% Outpatient – Shared Encounters with Physician(s) (may include some or all of the responsibilities listed)          

1.1.       Evaluates and manages patients in shared encounters with attending physician, including telehealth.

1. This should increase clinic access with a goal of doubling clinic volume since two providers will be sharing the clinic responsibilities.
2. Includes providing care to new, follow-up, acute, routine, and specialty patients.
3. Includes taking histories, performing physical examinations, interpreting diagnostic tests, collaborating on evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
4. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations
5. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.

1.2.       May first-assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate. 

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.

1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

5 % Outpatient – Care Coordination (may include some or all of the responsibilities listed)

1.1. Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning. DOES not include management of inpatients.

1.2. Coordinates episodic care and determines timing of routine clinic follow up.

1.3. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.

1.4. Attends department quality improvement meetings and participates in patient evaluation and planning.

1.5. Consults with nursing staff on plan and implementation of individualized nursing care plans. 

1.6. Independently provides case summaries for disability, insurance agencies, workers compensation, work releases, and medical supply agencies.