The University of California, San Francisco (UCSF) Heart & Vascular Center’s Advanced Heart Failure Comprehensive Care Center seeks a full-time Advanced Practice Provider (APP) to treat mechanical circulatory support (MCS), heart transplant, and advanced heart failure patients, among others.  The UCSF team consists of highly experienced physicians, surgeons, APPs, nurses, pharmacists, social workers, and researchers, caring for patients with advanced heart failure across the continuum of care. Our Advanced Heart Failure & MCS programs are nationally known for cutting edge advanced heart failure care and support in both the outpatient and inpatient setting and offers a variety of support systems (long-term and short-term).

The APP serves as primary provider in the hospital setting for these patients and will work closely with the Advanced Heart Failure Cardiologist, Cardiothoracic Surgery and Intensive Care teams along with nursing, case management, social workers and other multidisciplinary teams to evaluate, treat and manage this highly complex patient population in the Intensive Care and Acute Care Units.

Required Qualifications:

Graduation from a California Board of Registered Nursing approved or verified school of nursing with a master’s degree in nursing or a Doctor of Nursing Practice (DNP).

• Minimum of 4 years as a Nurse Practitioner in Cardiology, MCS, or Advanced Heart Failure 

• Minimum of 2 years managing mechanical circulatory support patients

• 3 years critical care nursing experience managing all MCS devices as a: impella, extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD)
   

Preferred Qualifications:

• Previous experience as an APP in managing Advanced Heart Failure Patients, Heart Transplant & MCS Patients

License/Certifications:

1. California Registered Nurse (RN) License without restriction
2. California Certified Nurse Practitioner (NP) without restriction
3. California Nurse Practitioner Furnishing Number including Schedule II furnishing privileges
4. NP national board certification from an accepted certifying agency aligned with the patient population and clinical role
Adult Inpatient (ACNP-BC, AGACNP-BC, ACNPC-AG, ACNPC). 
5. California Driver License (if required for position)
6. Drug Enforcement Administration (DEA) Registration with Schedules 2, 2N, 3, 3N, 4, and 5 registered to a California address
7. American Heart Association (AHA) Basic Life Support (BLS) certification
8. Additional required AHA certifications: ACLS
9. Additional required certifications (such as ENLS): None
 

Minimum Knowledge, Skills, and Abilities (KSA):    

1. Excellent verbal and written communication skills 
2. Judgement skills to effectively meet the needs of patients
3. Self-direction and organizational skills to function in an independent role
4. Ability to cope with personal stress experienced by health care providers and team members
5. Ability to meet minimum standards for hospital credentialing and billing standards as a billable provider
6. Submit health plan (Medicare, Medicaid, and commercial for all APPs; also, CCS for pediatric providers) enrollment by first clinical day 
7. At all times, must adhere to the UCSF Medical Staff Bylaws, Rules and Regulations, Code of Conduct, PRIDE values, and applicable medical center/campus/departmental policies and procedures
8. At all times, must adhere to all UCSF policies regarding HIPPA, privacy, communication, documentation, encounter closure, and billing
9. Mandatory attendance at the Office of Advanced Practice Providers Orientation Sessions
10. Mandatory attendance at the APP Onboarding Committee APP Onboarding Series
11. This position requires flexibility for the APP to work at all UCSF Health facilities/locations
12. Performs other duties as assigned

Preferred Knowledge, Skills, and Abilities (KSA):

1. EPIC experience

Responsibilities

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.