The Advanced Registered Nurse Practitioner (ARNP) in the MEIHSS program plays a pivotal leadership role within the in-home nursing services team, blending clinical expertise with administrative oversight. This position emphasizes operational supervision, staff development, interdepartmental coordination, and client-centered care planning. While the role does involve field responsibilities, its primary focus is management and clinical direction within a culturally responsive, elder-focused community setting.

1. Supervise a team of Registered Nurses, overseeing caseloads, delegation, documentation practices, and staff development through coaching, evaluations, and clinical mentoring.
2. Manage a panel of patients with acute and chronic health conditions, using evidence-based practices to promote health and prevent disease either independently or in collaboration with the primary care provider.
3. Provide technical supervision to nursing staff and serve as clinical resource on matters of patient care, medication administration, and nursing standards.
4. Prescribe pharmacologic and non-pharmacologic therapies in accordance with licensure and program scope, adjusting plans as needed to support optimal patient outcomes.
5. Order and interpret diagnostic studies, laboratory tests, and assessments; initiate referrals or specialty consults as clinically indicated.
6. Conduct patient education, caregiver training, and community outreach related to chronic disease management, end-of-life care, and wellness promotion.
7. Perform home visits selectively for complex patients, care escalations, or quality reviews, maintaining presence and understanding of field realities.
8. Participate in triage of client needs and high-risk events, providing case consultation and contributing to interdisciplinary problem solving.
9. Collaborate with APS (tribal and state), the tribal medical clinic, behavioral health, and social services to ensure safe, integrated care delivery.
10. Lead or assist in resolving conflicts involving clients, caregivers, or clinical staff using clear communication and mediation skills.
11. Conduct internal investigations related to patient complaints or staff performance concerns, ensuring objectivity, documentation, and follow-up.
12. Participate in audits, incident reviews, and program evaluations to uphold continuous quality improvement and organizational accountability.
13. Ensure compliance with all relevant policies and regulatory requirements including HIPAA, WAC (Washington Administrative Code), Medicare/Medicaid standards, and tribal codes.
14. Support and enforce performance management processes including disciplinary documentation, progressive correction, and formal feedback loops.
15. Attend regular team meetings and provide agenda items or training topics; contribute to the clinical education of new and current staff.
16. Serve as a liaison with the Elders Program and contribute to culturally relevant health planning.
17. Maintain appropriate licensure, DEA registration, certifications, and continuing education in accordance with professional standards.
18. Document all clinical activity and administrative action in the electronic health record or designated system of record.
19. Protect patient confidentiality and uphold ethical practices in all aspects of professional behavior.
20. Support program goals and community-based priorities, assisting with both office and outreach initiatives when appropriate.
21. Participate in organizational planning, budget discussions, and interdisciplinary leadership meetings to advance MEIHSS service delivery.
22. Because of the Tribe's commitment to community service and the well-being of its members, each employee may be expected to perform a wide range of office and field duties from time to time. Such duties may or may not be related to their regular responsibilities.

• Graduation from an accredited graduate-level program with a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP).
• Current Washington State license as an Advanced Registered Nurse Practitioner (ARNP).
• National board certification as a Family Nurse Practitioner (FNP) by ANCC, AANP, or equivalent.
• Three to five (3–5) years of experience in primary care or family medicine.
• At least one to two (1–2) years of experience working with geriatric populations.
• Current CPR and BLS certifications.
• Valid Washington State driver’s license.

Preferred: 

• Previous experience in a tribal health care environment.
• Background in psychiatric, behavioral health, or mental health services.
• Experience in conflict resolution, de-escalation strategies, and investigative processes.
• Understanding of trauma-informed care principles and culturally responsive healthcare.
• HR or healthcare administration experience is preferred but not required.
• Experience supervising or training other clinicians is highly desirable.

Skills:

• Clinical skills for hands-on evaluation and treatment of symptoms and disease processes in a family practice and home-based care environment.
• Patient assessment skills including collection of subjective/objective data, diagnostic reasoning, and treatment planning.
• Strong written and verbal communication skills, including documentation in EMRs and patient education.
• Time management and organizational skills to prioritize multiple responsibilities and delegate tasks effectively.
• Problem-solving and decision-making abilities involving assessment, planning, implementation, and evaluation.
• Teamwork and collaboration across clinical and administrative disciplines.
• Conflict resolution, de-escalation, and facilitation of sensitive conversations with patients, families, and staff.

Ability:

• Ability to evaluate, manage, and treat patients with a wide range of chronic and acute conditions.
• Capacity to conduct fall risk assessments, depression screenings, wound care, nutritional evaluations, and wellness exams.
• Skill in teaching clients, caregivers, and staff using appropriate educational models and communication styles.
• Ability to manage internal investigations and staff issues while maintaining professionalism, confidentiality, and fairness.
• Comfort working in high-stress, emotionally complex environments while upholding empathy and cultural sensitivity.
• Competency in EMR systems and compliance documentation for Medicare, Medicaid, and tribal health programs.

Knowledge:

• Deep understanding of geriatric care, including common concerns such as cognitive decline, falls, pressure injuries, polypharmacy, and frailty.
• Knowledge of chronic illnesses including diabetes, cardiovascular disease, COPD, and hypertension.
• Familiarity with pharmacologic and non-pharmacologic interventions, including immunizations and medication management.
• Awareness of HIPAA, WAC, tribal policies, and federal healthcare regulations.
• Insight into home healthcare reimbursement models, charting requirements, and interdisciplinary care coordination.

Work is performed primarily in an office or clinic setting, with occasional travel to patient homes or off-site meetings. The role requires the ability to sit, stand, walk, bend, and climb stairs as necessary in both clinical and residential environments. Routine use of computers, phones, and standard office equipment is expected. The provider must be able to occasionally lift, push, or pull up to 50 pounds, such as when carrying medical bags or assisting with equipment. While performing home visits, the ARNP may be exposed to unpredictable environmental conditions, such as uneven surfaces, cluttered walkways, or potential biohazards. Emotional resilience and the ability to remain calm under pressure are essential, as the role may involve responding to crises, behavioral escalations, or challenging family dynamics. Clear vision, hearing, and manual dexterity are necessary for patient assessment, documentation, and supervision.