Nurse Practitioner or Physician Assistant - Liver Transplant

GENERAL SUMMARY/ OVERVIEW STATEMENT: Under the direction of Daniel Pratt M.D. of the MGH Liver Transplant Program and Dr. James Markmann in collaboration with the Transplant Center Administrative Director and in accordance with the rules and regulations of Massachusetts governing Nurse Practitioners (NP) the NP will be responsible for the care of patients referred to MGH Liver Program. The NP will serve as a primary point person for access into the Liver Transplant Program as well as the management oftransplant patients and the primary point person for those patients with HCC in the pre post and peri phases of transplantation. He/she will perform the intake and triage for outpatients with advanced cirrhosis gather and review records from outside facilities interview patients by telephone to determine specialty consultations and studies needed gather studies/results from outside facilities coordinate testing and office visits at the MGH to ensure that results are available for the patient visit perform a preliminary patient evaluation (including a history and physical examination) on the day of the visit and provide patient teaching. The NP will coordinate any follow up testing or referrals as well as oversee medications as necessary. He/she will also serve as a dedicated relationship manager and liaison between the Liver Transplant Program and referring physicians. The goal is to grow Liver Transplant Program volume by ensuring easy access and exemplary customer service to patients and referring physicians and by increasing patient throughput.Position reports administratively to the Administrative Director of the Transplant Center and clinically to Dr. Daniel Pratt and Dr. James Markmann.PRINCIPAL DUTIES AND RESPONSIBILITIES:Facilitating Access Responsibilities:Working closely with Liver Transplant Program team leaders physicians transplant coordinators and their clinical and administrative staff is responsible for directing and coordinating inquiries and referrals to the appropriate service/physician and for fairly allocating undesignated referrals among the Liver Transplant Program physicians with interest and expertise in the management of end stage liver disease. Serves as central contact point for accepting and triaging referrals from referring physicians and selfreferred patients who do not have an existing relationship with a Liver Transplant Program physician. Triages care to appropriate Liver Transplant Program physician in accordance with established triage algorithms and clinical protocols. Conducts telephone interviews with patients and/or referring providers in order to collect all preliminary information necessary to direct the referral to the appropriate physician. Coordinates outpatient appointments with appropriate Liver Transplant physician(s) and transplant coordinators. Ensures timely appointments and facilitates access for patients into the system as soon as possible. Works collaboratively with surgeons and Hepatologists to identify and cultivate outreach opportunities including physician visits dinners grand rounds presentations etc Maintains strong relationships with admitting departments physicians nurses and clinic staffs to appointments and communication with referring physicians. Is familiar with each of the Liver Transplant physicians and their clinical and office staff in order to provide the highest level of triage. Communicates anticipated patient needs to appropriate physicians nurses and admitting departments. Facilitates throughput and quality patient care by daily collaboration with physicians nurses and admitting staff. Identifies and works with appropriate Liver Transplant and departmental leaders to resolve service delivery problems and recommends methods to improve and streamline services. Works with Liver Transplant physicians administration nursing staff admitting offices etc. to establish processes for prompt issue resolution within 24 hours of complaint. Patient Care Responsibilities:Primary management of adult patients with end stage liver disease and specifically the HCC population in the outpatient setting in conjunction with the Liver Transplant physicians. This includes daily review of test results and phone calls/emails from patients or referring doctors.New Referrals Previsit: Performs intake of data from referring doctor or from the patient if selfreferred. Review data with Liver Transplant physician and transplant coordinators to determine appropriate timing of MGH visit (e.g. urgent elective). Ensures that visits with multiple MGH Liver Transplant physicians are coordinated and scheduled in such a way as to optimize timely diagnosis and treatment. Determine what outside imaging studies (i.e. films CDs tapes) need to be forwarded to MGH for review and arrange for those to be sent in advance or brought by the patient. Determine what additional diagnostic studies need to be obtained at MGH and try to coordinate those with the patients visit(s). Notify the patient and referring physician regarding the timing of the visit(s) and associated testing. Confirms that all requested data has been received prior to visit. Reviews the imaging studies with a Liver Transplant physician. Summarizes the available information and create a preliminary draft of the consultation note. Day of the Visit to the MGH Liver Transplant Program: Obtains a detailed accurate medical history and performs a comprehensive physical examination on patients and amends the preliminary consultation. Assists in patient education. Subsequent to the Visit to the MGH Liver Transplant Program: Reviews the final interpretation of all lab results to determine that they are important findings. Proofreads the final consultation note and forwards it the referring physician promptly with phone contact in addition when appropriate When surgery or other intervention is planned oversees the necessary scheduling with surgeons endoscopy unit and the admitting office. Notifies patient and referring physician. Follows up on any other tests that were ordered after the visit (e.g. blood tests stress tests) and communicates results of outpatient testing to the patients Attends LBP Conference as appropriate Communicate findings and care plan to transplant team and referring physicians. Listed phase Sees all patients in followup in clinic under the direction of the physician. Communicates with MGH Liver Transplant Program outpatients routinely regarding their status on the transplant list making medication adjustments as necessary (under the direction of a Program physician). Develops systems to ensure that patients are not lost to follow up. Communication with transplant coordinators is critical to efficiently track patients in the evaluation and listing process. Receives the routine clinical questions or updates from patients whether by phone or email Reviews patient questions with physician when appropriate and responds Documents all patient conversations or emails in the electronic medical record Is responsible for insuring timely completion of testing needed for UNOS HCC upgrades Will enter UNOS upgrade information to secure HCC priority points Attends LBP and HCC conferences as well as listing meetings and presents patients issues as needed PostTransplant Phase Provides care within his or her scope of practice and licensure in the outpatient setting to achieve optimal physical social and emotional rehabilitation. Insures that post transplant HCC surveillance is completed per standard protocol Identifies and responds to recipient/family/legal guardians educational psychosocial and economic needs in the posttransplant phase. Reinforces education and followup requirements necessary for successful outcome. Observes monitors and assesses recipients compliance with medications and medical regimen; collaborates with the transplant team to attain and maintain compliance. Collects and reviews data pertinent to recipients health and organ function and ensures that the information is documented in the patients chart/OnCall. Communicates lab data and diagnostic results to transplant physician/health care provider. Implements changes in drug/treatment therapy as ordered by physicians and other credentialed health care providers. Understands posttransplant protocols and acts as a resource for internal and external health care providers. Arranges for consultations diagnostic procedures and hospitalization when indicated. Maintains communication with referring physician and other health care providers. Provides and maintains comprehensive documentation in patient medical record. Identifies and responds to the educational psychosocial and economic needs of transplant recipients/live organ donors and families during the posttransplant/followup phase. Educational: Develops and implements routine patient instructions for end stage liver disease management Acts as a resource to other care providers with questions about end stage liver disease management Assists in current clinical research and pursues independent clinical research Relationship Management Responsibilities NP is responsible for maintaining relationships with new and existing referring physicians and their clinical and office staff. Serves as a liaison and facilitator of communication between physicians administration and community. Works closely with MGH Network Development and Outreach Program to provide information to support outreach visits/efforts. Works closely with Liver Transplant Program and departmental leaders to address any access or operational issues identified through feedback from referring physicians or patients in the course of the Network Development and Outreach Programs efforts. Identifies and monitors relationship histories including details of prior referrals from referral sources and referrers preferred communication methods by maintaining information in the relationshipmanagement database. Identifies and summarizes referring physician/center/clinician needs to the Liver Transplant Program physicians coordinators and leadership. In conjunction with Liver Transplant Program physicians coordinators and leadership develops standards for communication with referring physicians/centers/clinicians and works with Liver Transplant Program physicians coordinators and leadership to implement. In regard to specific referrals actively communicates patients progress and discharge plans to referring physician and assure that communication is maintained throughout admission at discharge and after outpatient visits. Followsup on all requests to ensure satisfied patients and referring physicians. Documents and reports all physician questions concerns complaints and resolutions. Assists in transfers to and from the emergency department intensive care units and hospital floors. Acts as a resource to other clinical specialties. Other Responsibilities Participates as requested in MGH Partners and Transplant Center quality initiatives. Participates in various hospital system and Center committees as assigned. Develops and maintains tracking system to determine program effectiveness. Meets routinely with supervisors and Liver Transplant Program physicians coordinators and leadership to review statistics progress and overall performance of the program and to report on activities referral patterns customer satisfaction problems and recommendations Participates in aspects of research involving study planning performance of the research analysis of data and publications. Attends internal and external education meetings and reads appropriate professional journals in order to maintain and enhance skills and clinical competence. Is encouraged to advance his/her medical and technical skills as appropriate to deliver optimum patient care. QUALIFICATIONS FOR AN NP:Masters degree in NP program.Current Registered NP licensure in Massachusetts. Qualified in all basic and advanced cardiac life support standards as established by the American Heart Association. Possess the maturity selfconfidence and ability to develop and maintain a multidisciplinary program to support the management of patients with end stage liver disease. The ideal candidate would have 35 years experience as an NP and prior experience in liver transplantation. Must be a highly motivated individual who will work in a collaborative manner with physicians and other clinicians. QUALIFICATIONS FOR A PA: Current Physician Assistant licensure in Massachusetts. Current certification as a Physician Assistant and authorization to practice as a Physician Assistant in Massachusetts. Masters degree required. Minimum of 2 years relevant clinical experience. SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: Must be a highly motivated individual who has a proven track record of working with diverse healthcare teams. Will work in a collaborative manner with physicians and other clinicians. Professional knowledge: Clinical healthcare management and marketing knowledge to enable effective interactions and communications with clinicians healthcare administrators and marketing professionals. Time Management: Exceptional organizational skills and ability to prioritize effectively and complete tasks; Flexibility to handle multiple tasks and deadline pressures. Leadership: Highly motivated independent and capable of performing in a complex environment; Strong sense of initiative and perseverance to carry through to completion of tasks; Demonstrates forthrightness and integrity. Ability to identify issues/projects and initiate plans to address asking for direction when appropriate. Ability to develop a common vision for diverse constituents communicate effectively sell ideas and take ownership and responsibility for activities. Interpersonal/communication: Excellent interpersonal written and oral communication and public speaking skills. Good command of English language including medical and scientific terminology. Information Systems/Technology Skills: Exceptional computer skills (including operating systems word processing database electronic mail Internet spreadsheets and other office management systems). Ability to develop and maintain databases and associated analysis and reporting. Quality Assurance: Skills to work efficiently and effectively and strive to do so in all aspects of position; Effective project management skills and attention to detail. Critical Thinking/Decision Making: Ability to appropriately evaluate all aspects of a situation and to independently make appropriate and timely decisions. Personnel Management: Ability to coordinate among diverse constituents. Fiscal Responsibility: Effective financial and analytical skills including ability to ensure appropriate use of resources. Discretion and Confidentiality: Ability to handle sensitive and confidential matters discreetly and to ensure confidentiality guidelines are mMassachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills perspectives and ideas we choose to lead. Applications fromprotected veterans and individuals with disabilities are strongly encouraged.