Nurse Practitioner - PACC (Home Assisted Ventilation Program)

Columbia University Irving Medical Center (CUIMC) seeks an experienced Nurse Practitioner to help build and expand the newly established Claire Tow Home Assisted Ventilation Program within the Division of Pulmonary, Allergy, and Critical Care Medicine.

The Program delivers advanced, multidisciplinary care to adults requiring long-term noninvasive, portable, or tracheostomy ventilation to safely live at home, including patients with neuromuscular diseases such as amyotrophic lateral sclerosis (ALS), severe chronic obstructive pulmonary disease (COPD), and chronic hypercapnic respiratory failure.

As the Program's inaugural Nurse Practitioner, the incumbent will primarily provide longitudinal follow-up care to established patients, with opportunities to evaluate new referrals based on interest and program needs. Working collaboratively with pulmonary physicians, respiratory therapists, neurology providers, and sleep medicine specialists, the Nurse Practitioner will play a key role in developing clinical pathways, enhancing patient outcomes, and advancing the Program's clinical and academic mission.

Longitudinal Follow-Up Care

• Serve as a primary provider for follow-up visits of established program patients.
• Reassess respiratory status, symptom burden, and adherence to ventilatory therapy.
• Order, obtain, and interpret pulmonary function testing, respiratory muscle strength assessments, peak cough flow measurements, blood gases, transcutaneous and end-tidal carbon dioxide monitoring, overnight oximetry, and ventilator compliance data.

Ventilation Prescription and Management

• Develop, modify, and manage ventilation prescriptions, including ventilation mode, pressure settings, backup respiratory rate, and interface selection.
• Establish physiologic treatment goals and perform ambulatory in-clinic ventilator titration.
• Collaborate with respiratory therapists on device optimization, troubleshooting, and mask fitting.
• Prescribe airway clearance therapies, cough augmentation devices, supplemental oxygen, suction equipment, and other related respiratory support therapies.

Telemonitoring and Interval Management

• Review and interpret ventilator compliance and remote monitoring data independently or in collaboration with respiratory therapy staff.
• Adjust treatment plans based on clinical findings, escalate care when appropriate, and coordinate additional diagnostic evaluations between visits.

Patient Education and Advance Care Planning

• Provide education regarding disease progression, prognosis, respiratory support options, and symptom management.
• Deliver anticipatory guidance aimed at preventing respiratory crises and avoidable hospitalizations.
• Conduct goals-of-care discussions and advance care planning related to long-term ventilation, tracheostomy, and palliative care options.

Care Coordination and Authorization

• Complete letters of medical necessity and detailed written orders for durable medical equipment (DME).
• Manage insurance authorizations, peer-to-peer reviews, appeals, and supporting documentation for ventilators, cough assist devices, and related respiratory equipment.
• Coordinate care across multidisciplinary providers and community resources.

New Referral Evaluation (Optional)

• Evaluate new referrals for chronic respiratory failure and nocturnal hypoventilation.
• Assess patients following hospitalization for acute hypercapnic respiratory failure and determine eligibility for home ventilation.
• Identify contributing conditions, including obesity hypoventilation syndrome, sleep-disordered breathing, and neuromuscular disease.

Program Development and Education

• Support quality improvement initiatives and outcomes tracking.
• Assist in the development of clinical workflows, protocols, and best practices.
• Provide education and mentorship to nursing staff, respiratory therapists, fellows, residents, and students.

Additional Responsibilities

• Obtain and document patient histories, perform medication reconciliation and physical examinations, and develop treatment plans in accordance with established protocols and practice agreements.
• Prescribe medications and therapies in compliance with New York State and federal regulations.
• Maintain accurate and timely documentation in the electronic health record.
• Participate in peer review, utilization review, competency evaluations, and departmental quality activities.
• Support coding, billing, and compliance initiatives as appropriate.
• Perform other related duties as assigned.