University of Virginia Pre-Hospital Clinician - Community Paramedicine (Population Health Dept) in Charlottesville, Virginia
Community Paramedicine (CP) represents an expanded role for prehospital clinicians to interact with clients/patients outside of the traditional health care system with the goal of improving health outcomes by connecting underserved populations with underutilized resources. Patient populations that may be at increased risk for failure of their outpatient health care plans and could benefit from the CP program will be identified through a variety of strategies including the discharge planning process for inpatients, emergency department discharge planning processes, frequent utilization of the emergency services system, and identification of members of vulnerable populations in communities that have historically faced barriers to successful health care outcomes. The goal of the CP program is to be able to identify a variety of challenges to the successful completion of health care strategies through visits with patients/clients in the community and facilitate successful completion of existing health care plans, and to identify novel and unrecognized opportunities for improvement in their health by assisting patients in accessing additional resources in the community. The CP program is not designed to duplicate existing resources in the community, but to develop expertise in the interaction with, and assessment of, clients/patients and facilitating the ability of clients/patients to access appropriate resources and be successful in achieving their health care goals.
The Pre-Hospital Clinician for Community Paramedicine is an expanded role to connect underutilized resources to underserved patient populations. The model designed seeks to mitigate long-standing health disparities experienced in both inner-city and rural areas. Using clinical outcome data, geo-mapped to specific communities, the Pre-Hospital Clinician will partner with multiple EMS agencies, as well as fire stations and Community Health Worker programs to serve communities and proactively address clinical needs that have historically contributed or led to admissions, readmissions, preventable Emergency Department and non-emergent 911 utilization, as well as leaving AMA or without being seen in the Emergency Department.
The UVA Health, Population Health department strives to improve the patient experience, the quality of care and outcomes while managing costs for multiple populations of people including vulnerable patients who face healthcare barriers, inequities and disparities, as well as to bring significant health concerns into focus so that issues can be addressed by matching needs to resource allocation as a means to overcome the barriers to healthcare that drive poor health conditions. Population Health seeks opportunities to collaborate internally and with other agencies and organizations to improve the health outcomes within the local, regional and state areas in order to best care for the patient populations served.
This program will include services and resources within the Population Health department such as personalized, in-home or community care, personalized advocacy, behavioral health, clinical and pharmacy support and escalation for interventions in real-time patient care including video and photo support. Patients can be eligible for enrollment into other Population Health programs and resources, as appropriate.
As defined by the Community Paramedicine Medical Director and subject to change, the scope of practice will include:
· Patient assessment including vital signs, physical assessment as indicated/required, point-of-care (POC) testing including glucometry, blood count and chemistries, testing for infectious diseases, e.g. COVID 19, as needed
· Administration of vaccines as indicated and/or directed
· Obtaining specimens for laboratory testing including phlebotomy, viral testing, etc.
· Obtaining EKGs as necessary
· Wound care, assessment, and dressing changes
· Provision of emergency care within their scope of practice as a certified EMS provider in Virginia as needed while accessing the 911 system and participating in that emergency care as needed.
Conducts review of the EMR and any documentation provided to the patient from recent inpatient, outpatient, or emergency department visits.
· Review of current medications to ensure that the patient has been able to fill discharge prescriptions and that their medication supply is sufficient or if refills are needed.
· Address any concerns or confusion about discharge plans and facilitate the filling of prescriptions, and attending any follow-up appointments.
· Review any required health care equipment, e.g. home oxygen equipment, nebulizers, walkers or other gait assistance equipment, and ensure it is functional and assist the patient in obtaining the equipment if challenges have been encountered
· Participation and facilitation in telemedicine opportunities, both previously scheduled as well as initiated during the CP visit
Provide patient and family/caregiver education and guidance at any point prior to, during, and/or after the inpatient stay, ED visit, ambulatory referral or outpatient appointment(s), including:
· Serves as touchpoint and navigator between patients, patient care teams, outpatient SNF, IRF, ambulatory, specialty, and community Providers, appropriate resources, and UVA Health programs throughout the health system, local, regional, state and federal agencies.
· Manages enrollment and assessments which can include: the PHQ depression inventory, SDoH survey tool, falls risk, social isolation risks, GAD, and/or other assessments, as needed.
· Reviews all assessments and/or patient concerns, needs or requests to manage navigation of resource allocation including, but not limited to: Behavioral Health, Disease Management, Financial Assistance, Medicare/Medicaid enrollment/assistance
· Can also refer to an advocate for transportation, scheduling of appointments and requests for provider referrals, social work and/or case management care plans, ICPs, medication reconciliation and pharmacy needs, PCP establishment referrals, housing, food insecurity, health literacy, safe environment and home accommodations for disabilities or physical challenges, and other discovered needs
· Communicates to provider(s) or clinical team, as well as other agencies involved in the overall care of the patient and actions as part of the initial assessment
· Documents all encounters in Epic and Population Heath systems and if needed, DRG, recent ED visits since last CP or primary care follow-up for the most recent 30, 60, and 90 days
Will stay up-to-date and manage any billable services in Epic
Will be familiar with electronic patient care records for prehospital care, and requirements for reporting of CP activities to the Virginia Department of Health, Office of Emergency Medical Services (OEMS)
All vitals are to be uploaded in Population Health platforms for Epic integration of data in real-time, share trends, concerns, issues with appropriate clinical care teams
Primary or Specialty Care LIPs and care teams will be notified through Epic of most recent visit and documentation note routed to appropriate LIP and/or clinical care team
Communicates regularly with patients to follow-up on progress and review/discuss barriers or challenges to health care, environmental, patient experience, or any flagged SDoH need, as well as potential adjustments to any identified need. This information is then shared with providers, clinical care teams, associated agencies of care including, but not limited to: Home Health, SNF partners, IRF, homeless shelter partners all with the goal of effective and comprehensive resolution.
Places orders for Interactive Home Monitoring (IHM) Telemedicine Program and provides patient education on the use of iPad, clinical overview and escalation, equipment, Bluetooth capabilities, etc.
· Provides patient and provider education and outreach on use of all programs to the ED, inpatient, ambulatory, outpatient specialty clinics on programmatic offerings, benefits, processes, protocols, and help chains.
· Collaborates with assigned advocate, Home Health, homeless shelter, and SNF or IRF agencies for scheduling, order placement, patient concerns, needs, resources, and to address issues with any of these agencies on behalf of the patient
May, from time-to-time, provide education on any interactive and Telemedicine programs to leadership, data science teams, clinicians, outside agencies, emergency departments, etc.
Reviews and maintains charts and facilitates patient accessibility to this information.
· Makes certain all pertinent information is available for providers and takes necessary steps to obtain information by thoroughly reviewing charts, following-up on lab orders, pharmacy needs, internal/external referrals and other needs as addressed by assessments and outreach
· Utilizes chronic condition based algorithms to drive panel and patient actions under the direction of the Medical Director, APP and LIP provider(s) and care teams, as well as external agencies
· Enrolls patients in My Chart program, if applicable, other UVA Health driven programs to benefit patient needs and communication
Reviews and understands patient assessments, ICPs, DTPs, patient discharge summaries, and researches clinical indicators
· Thoroughly researches patient records in EPIC and other electronic systems to understand past and current needs, Provider expectations and follow-up requests, referrals, appointments, special care needs, resources, unidentified barriers to care, SDoH needs, etc.
· Follow-up with Medical Director, other providers, care teams, pharmacists, and Population Health clinicians to address needs such as referrals for specialty appointments, prescriptions, instructions on wound care, patient reporting of vitals data, patient concerns, health literacy needs, escalation of care, bridging Primary Care, and establishment of a PCP
· Identify any behavioral health diagnoses, past or present needs including, but not limited to counseling, trauma care, referrals to psychiatrists, medication needs associated with behavioral health diagnoses especially in patients without an established PCP and provide referrals to departmental therapists/social workers to assist
· Researches additional clinical indicators as designated by the provider(s) and/or clinical teams
Collaborates with teams across multiple clinics and areas
· May work in a patient’s home, on the streets, at multiple clinics including on and off Grounds, as well as the Medical Center
· Participates in team projects including daily huddles, regular team meetings and trainings, programmatic design opportunities, resource development, and continuing education
· Maintains knowledge of resources and continually builds relationships and opportunities to open doors that provide better patient outcomes, experiences and overall care as identified by providers, clinical care teams, specialists, with continual assessment of outcomes and barriers to care
· Solid understanding and following of standardized work and workflows, referral processes, program design and redesign, troubleshooting, enhancement, and the A3 process
· Fully addresses win-win solutions to identified patient needs to resolution, wherever possible
Wound care including assessment, wound care, and dressings
Familiarity with EPIC including the review of discharge summaries, after-visit-summaries (AVS), and entering patient care contacts
Review Future Appointments
Home access check, ramp, bathroom, kitchen, bedroom etc./Safety inspection
Smoke Detector check
Check/review Home O2 delivery system
Provide supplemental oxygen via nasal cannula, simple mask, venturi system, non-rebreather mask
Provide/Assist with nebulized medication treatment, troubleshoot home nebulizer equipment
Assist with home medication administration as needed
Assist with home devices, e.g. foley catheters
Pulmonary function measurement, e.g. forced expiratory velocity (FEV)
Ability to send/transmit pictures/videos
Scale for weight measurement
Body substance isolation / PPE
Endtidal capnography monitoring (ETCO2)
Constant positive airway pressure (CPAP)
IV Access and fluid
IV Blood draw and blood specimen collection
IV medication administration
Blood chemistry analysis
Place bladder catheter
Potential for ultrasonography
ECG acquisition (12 lead)
ECG rhythm interpretation
Patient restraint, physical/medication
Trephination of nails
Vagal Maneuvers/Carotid massage
Delivery of a newborn if needed
Foreign body removal
Nasal/Oral gastric tube placement
Tourniquets use as needed to control bleeding in emergency
Care of the fractures or dislocations
Care of the amputated part
Spine immobilizations techniques
Some of these procedures above would require that the CP medics be responding in a permitted advanced life support (ALS) unit, both to provide care and to possess the equipment required to provide that level of care. That is do-able, and can be done under the MTN agency license, but is a significant step up in equipment. The medics are capable of providing those services within their scope of care.
Position Compensation Range: $19.49 - $30.21 Hourly
Education: High School Graduate.
Experience: 1-year experience in a clinical/field environment and/or advocate or navigator role, knowledge and proficient use of Epic preferred. Advanced life support experience preferred.
Certification: Virginia Department of Health Emergency Medical Technician – Intermediate or Paramedic required. Paramedic preferred Valid Virginia Driver’s License (VADL) required. American Heart Association (AHA) Health Care Provider BLS certification required. PALS and Emergency Vehicle Operator Course (EVOC) Level II or higher required to operate a vehicle within 6 months of hire.
Must be willing to work a Monday – Friday schedule.
* APPLICANTS MUST SUBMIT RESUME WITH APPLICATION *
Job requires standing for prolonged periods, frequently bending/stooping/traveling, climbing (ladder, steps) and driving. Proficient communication, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull >100lbs. May be exposed to fumes, chemicals, vibrations, humidity, cold, heat, noise, outdoor climate, blood/body fluids and infectious disease.
COVID Vaccination Requirement and Guidelines
Please visit the UVA COVID-19 Job Requirements and Guidelines (https://hr.virginia.edu/uva-covid-19-job-requirements-and-guidelines) webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.
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