Description
AuthoraCare Collective is currently seeking a Nurse Practitioner - Palliative Care (Facility-based). This is a full-time position; Monday - Friday 8:00am - 5:00pmsupporting Forsyth, Davie and Davidson Counties.
CPR certification from the American Heart Association or American Red Cross Basic Life Support (BLS) is required.
The Facility Based Palliative Care Nurse Practitioner (NP) provides consultative palliative care to adults with serious, progressive, or life-limiting illness who reside in skilled nursing facilities, assisted living communities, memory care settings, and other contracted residential care environments. The NP focuses on symptom management, goals-of-care discussions, advance care planning, caregiver support, prognostic communication, and coordination across care settings.
The NP works collaboratively with the attending provider, facility clinical team, patient, family, and interdisciplinary team to develop recommendations and an individualized palliative plan of care. Clinical services may include evaluation and management of pain and other distressing symptoms, medication recommendations or prescribing within organizational protocols and scope of practice, serious-illness communication, support for complex medical decision-making, and assessment for hospice eligibility or other appropriate care transitions.
The NP builds therapeutic relationships with patients and caregivers and provides clear education, emotional support, and anticipatory guidance. The role requires effective verbal and written communication with patients, families, facility staff, physicians, pharmacists, hospice and home health teams, and community service organizations. Participation in on-call coverage for the palliative care population may be required as assigned.
Our team members enjoy the following benefits: Competitive salaries and a comprehensive benefit package which includes paid time off (PTO), seven paid holidays, medical, dental, vision, disability, and life insurance, and 403B match after 12 months of service. Other benefits include mileage reimbursement, flexible work schedules, professional growth and development opportunities, and employee engagement activities.
Requirements
Education and Experience:
• Graduate of an accredited School of Nursing with completion of an accredited NP program.
• Current, unrestricted NP license and RN license in North Carolina, with prescriptive authority as required for the role.
• Current national board certification as an NP in an applicable population focus.
• Current DEA registration and controlled-substance prescribing authority, if required by assigned duties.
• Minimum of 2 years of clinical experience in palliative care, hospice, geriatrics, LTC, SNF, acute care, or outpatient practice required.
• Palliative care or hospice experience strongly preferred; specialty certification in hospice and palliative nursing encouraged.
• Excellent clinical assessment, communication, relationship-building, and serious-illness communication skills.
• Other: Valid state-issued driver's license required. Must carry automobile liability insurance at limits required by agency. Must have own transportation.
Patient Care and Palliative Consultation
a. Conduct comprehensive palliative assessments, including medical history, physical examination, functional and cognitive status, symptom burden, psychosocial needs, caregiver concerns, and spiritual or cultural factors that may affect care.
b. Evaluate and manage pain, dyspnea, nausea, constipation, fatigue, anxiety, depression, delirium, anorexia, insomnia, secretions, and other distressing symptoms associated with serious illness.
c. Develop an individualized palliative plan of care that reflects the patient's condition, values, goals, prognosis, treatment preferences, and desired level of intervention.
d. Prescribe medications and therapies, or communicate evidence-based recommendations to the attending or facility provider, consistent with scope of practice, organizational protocols, facility agreements, and the established care model.
e. Review medication regimens for symptom benefit, burden, adverse effects, drug interactions, and opportunities for deprescribing in collaboration with the appropriate prescriber and pharmacist.
f. Monitor response to interventions and revise the palliative plan based on clinical changes, patient priorities, and interdisciplinary input.
g. Identify urgent or emergent concerns and coordinate timely escalation while considering the patient's documented preferences and GOC.
h. Assess hospice eligibility and readiness, provide education, and support timely referral when hospice is clinically appropriate and consistent with patient and family goals.
i. Provide follow-up palliative visits at a frequency based on clinical need, program criteria, and contractual expectations.
Documentation Quality and Compliance
a. Complete accurate, clinically meaningful, and timely documentation in the EMR in accordance with organizational policy, payer requirements, and regulatory standards.
b. Document symptom assessment, clinical reasoning, patient values, GOC, risk and benefit discussions, decision-making capacity when relevant, and prognosis-informed discussions when clinically appropriate.
c. Clearly document the palliative care plan, recommendations, responsible follow-up party, and communication with the attending provider and facility team.
d. Use appropriate diagnoses and billing codes and support medical necessity through complete documentation.
e. Maintain compliance with HIPAA, healthcare laws, professional standards, facility requirements, and organizational policies.
f. Meet established expectations for visit productivity, documentation timeliness, follow-up, quality, and patient or facility communication.
g. Participate in chart review, peer review, QI, and corrective action activities when indicated.
Care Coordination and Team Collaboration
a. Collaborate with attending physicians, PCPs, facility medical providers, nursing staff, SWs, pharmacists, hospice and home health teams, and other care partners to develop and update the palliative plan of care.
b. Communicate consultation findings, recommendations, medication changes, and follow-up needs clearly and promptly to the patient, family, facility team, and responsible medical provider.
c. Coordinate diagnostic testing, referrals, community resources, and follow-up services when indicated and within the palliative care service scope.
d. Support transitions between the facility, ED, hospital, rehabilitation, hospice, and other settings to reduce fragmentation and promote goal-concordant care.
e. Clarify which clinician or service is responsible for implementing recommendations, placing orders, and monitoring results when responsibility is not defined by the care model.
f. Participate in facility care conferences, IDG meetings, departmental meetings, and case reviews as assigned.
g. Engage in interdisciplinary problem-solving to address changes in condition, complex family dynamics, caregiver distress, ethical concerns, and barriers to the plan of care.
h. Build productive relationships with facility leaders and staff and provide education regarding palliative care scope, referral criteria, and available support.
i. Assume on-call responsibilities as scheduled, if applicable, to support continuity of palliative care.
j. Participate in QI activities, special projects, and ongoing professional development.
Patient Family and Facility Education
a. Educate patients and families about illness progression, symptom management, medication use, expected changes, and when to seek additional help.
b. Provide anticipatory guidance to reduce crisis-driven decision-making and help patients and families prepare for likely changes.
c. Explain the differences among palliative care, primary care, hospice, home health, and emergency services.
d. Provide education and clinical guidance to facility staff within the scope of the consultation and organizational agreements.
e. Support shared decision-making without directing patients or families toward a predetermined treatment choice.
Goals of Care and Advance Care Planning
a. Elicit and document the patient's understanding of illness, values, care priorities, acceptable quality of life, surrogate decision-maker, and preferences for future treatment.
b. Facilitate GOC and ACP discussions using prognosis-informed, culturally responsive, and patient-centered communication.
c. Explain the expected benefits, burdens, and alternatives of major treatment decisions, including hospitalization, artificial nutrition and hydration, resuscitation, and other life-sustaining treatments when clinically relevant.
d. Assess decision-making capacity when indicated and engage the legally authorized representative or surrogate consistent with applicable law and organizational policy.
e. Support completion and availability of advance directives, MOST forms, code-status documentation, and other applicable documents within scope and policy.
f. Revisit GOC after a significant change in condition, hospitalization, functional decline, or change in patient or family priorities.
Required Skills Abilities and Professional Expectations
• Ability to assess and manage complex symptoms in facility settings with limited immediate diagnostic resources.
• Strong clinical judgment in determining when escalation, hospitalization, hospice referral, or a comfort-focused approach is appropriate and aligned with the patient's goals.
• Comfort with independent clinical decision-making while collaborating closely with physicians, facility clinicians, and the interdisciplinary team.
• Ability to clearly distinguish the palliative care consultant role from primary care, facility medical management, hospice, and emergency services.
• Knowledge of serious-illness trajectories, prognostication, symptom management, ACP, code-status discussions, and hospice eligibility considerations.
• Ability to establish collaborative relationships with facility leadership and staff while maintaining appropriate professional boundaries and role clarity.
• Excellent verbal and written communication skills, including communication during emotionally complex or high-conflict situations.
• Strong computer skills and proficiency with EMRs, telephones, and other tools required for clinical documentation and communication.
• Ability to act with integrity, professionalism, cultural humility, and confidentiality.
• Strong prioritization, time-management, and organizational skills, with the ability to work independently amid frequent interruptions and competing needs.
• Proficiency in reading, writing, and speaking English to complete the essential functions of the position.
• Physical ability to bend, stoop, perform repetitive hand and wrist movements, climb stairs, walk distances, and navigate facility environments.
• Ability to travel to, enter, and function safely in facilities throughout the assigned service area.
• Ability to use correct body mechanics when lifting more than 30 lb or assisting with clinical equipment, consistent with organizational policy.
