Job Description
myPlace Health is built around a simple but powerful belief: older adults deserve the support they need to live safely, independently, and with dignity in their own communities. As a PACE (Program of All Inclusive Care for the Elderly) organization backed by SCAN Group, myPlace Health brings together customized medical care, social activities, and daily support for participants and their families – all under one roof. Our centers are more than healthcare facilities. They are vibrant community hubs where participants are known by name, valued, and supported as whole people. Behind that experience is a dedicated, interdisciplinary team working together to coordinate care, remove barriers, and improve quality of life for some of the most medically and socially complex populations. For employees, myPlace Health offers the opportunity to do deeply meaningful work in a highly collaborative setting. Team members are encouraged to contribute innovative ideas, and grow alongside a mission that prioritizes compassion, respect, and impact. The result is a culture where people feel connected—to their colleagues, their participants, and the communities they serve. At myPlace Health, work is more than a job. It’s a shared commitment to honoring what matters most. This is an opportunity for a mission-driven Nurse Practitioner who’s passionate about helping high-risk seniors and frail older adults live the independent lives they deserve. As a key member of our Interdisciplinary Team (IDT), you’ll provide direct medical care and lead a panel of participants—building trusted relationships and driving care plans that improve outcomes. You’ll meet participants where they are—primarily in the center/clinic, with occasional home visits, virtual care, or other sites as needed. This role is Monday–Friday with regular hours, plus shared on-call rotation support. If you thrive in a collaborative, high-growth environment, you’ll feel right at home here. Responsibilities: Be a core clinical voice on the IDT: Partner with the Interdisciplinary Team to complete key assessment sections, contribute to care planning, and support service determination requests. Own and grow your participant panel: Actively build relationships with participants and manage an ongoing panel with continuity, accountability, and heart. Practice thoughtful, safe prescribing: Initiate, evaluate, review, and update medication and treatment orders (including diagnostic studies) with required approval. Coordinate care in real time: Assess, initiate, and coordinate day-to-day care under supervision—keeping participants stable, supported, and progressing toward goals. Chart with excellence and timeliness: Document participant interactions, assessments, and next steps in the EMR within established center timeframes. Connect participants to the right specialists: Make referrals, request consults, and ensure follow-through with approval—helping participants navigate complex systems with ease. Deliver comprehensive clinical care: Perform histories and physicals, provide participant education, and support informed decision-making at every step. Stay on top of labs and clinical results: Order, interpret, and follow up on lab tests and results—closing loops and acting quickly when needed. Use your hands-on skills where appropriate: Perform selected procedures within scope and support high-quality, efficient care delivery. Spot changes early and escalate appropriately: Recognize abnormalities, respond with clinical judgment, and escalate concerns to ensure participant safety. Collaborate across disciplines: Work closely with behavioral health, pharmacy, and other care partners to ensure wraparound, whole-person care. Meet participants where they are: Evaluate and treat participants in the center, at home, virtually, in SNFs, and other settings—delivering care across the continuum. Support meaningful goals-of-care conversations: Facilitate advance care planning discussions with participants and caregivers with empathy and clarity. Capture acuity accurately: Document chronic conditions through HCC capture to reflect true clinical complexity and support appropriate care planning. Pitch in when it matters most: Provide on-call coverage as needed, supporting timely guidance and continuity for participants. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of myPlace's Vision and Goals. Other duties as a