Oak Street Health is seeking a Nurse Practitioner to provide high-quality, patient-centered primary care to adults on Medicare in underserved communities. In this role, you'll deliver comprehensive assessments, manage chronic and acute conditions, and collaborate closely with a multidisciplinary care team to improve patient outcomes. You will focus on preventive care, education, and care coordination, leveraging data and best practices to support value-based care. Oak Street Health offers a supportive, inclusive environment with robust professional development and the opportunity to make a meaningful community impact.
Responsibilities
- Provide comprehensive primary and preventive care to a panel of adult Medicare patients, focusing on chronic disease management and health maintenance.
- Perform advanced clinical assessments, formulate diagnoses, and develop evidence-based treatment and care plans for acute and chronic conditions.
- Order, perform, and interpret laboratory tests, imaging, and other diagnostics; adjust care plans and medications based on results and patient response.
- Prescribe and manage medications in accordance with state and federal regulations, including controlled substances where appropriate.
- Document all patient encounters, care plans, and communications accurately and timely in the electronic health record (EHR).
- Collaborate closely with physicians, nurses, care managers, social workers, and other team members to coordinate holistic, team-based care.
- Engage patients and families in education, counseling, and shared decision-making to support understanding of conditions, treatments, and self-care strategies.
- Participate in population health initiatives by identifying and closing preventive care and chronic disease management gaps using available data and quality metrics.
- Contribute to quality improvement efforts, adhering to clinical guidelines and organizational protocols to meet or exceed performance and outcome targets.
- Utilize in-person visits and, when appropriate, telehealth modalities to maintain access and continuity of care for patients.
- Maintain required licenses, certifications, and continuing education to sustain a high level of clinical competence and compliance with regulatory standards.
- Support Oak Street Health's mission by promoting a patient-centered, inclusive, and culturally sensitive care environment for underserved communities.
Required Skills
- Advanced clinical assessment and diagnosis
- Chronic disease management (e.g., diabetes, COPD, CHF)
- Primary and preventive care planning
- Electronic Health Record (EHR) documentation
- Ordering and interpreting labs and diagnostics
- Medication management and prescribing
- Care coordination within interdisciplinary teams
- Patient and family education
- Population health management
- Motivational interviewing
- Culturally competent care delivery
- Quality and performance improvement
- Basic telehealth practice
- Time management and panel management
