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Advanced Practice Primary Care Clinician

Company: Commonwealth Care Alliance
Location: Springfield
Posted on: May 10, 2020

Job Description:

At Commonwealth Care Alliance (CCA), our vision is to lead the way in transforming the nation's healthcare for individuals with the most significant needs. If being part of a team and working on combined solutions for patients matters to you---keep reading. We may have something to talk about.Commonwealth Community Care's (CCC) Primary Care NP/PA provides comprehensive primary care delivery and care coordination to adults of all ages, specializing in those who have complex physical, developmental, intellectual, and behavioral health conditions, requiring extensive clinical support. Care is delivered in the office, home, inpatient facility, or community-based on the members' individual needs. The Primary Care NP/PA works closely within and must be comfortable guiding an interdisciplinary care team involved in their members' care. This role will provide ongoing chronic disease management, urgent visits, promote preventative care and wellness, and provide end of life/palliative care. The role also includes a compendium of care management/ care coordination functions encompassing the development and implementation of the member-centric individualized care plan along with authorization of appropriate durable medical equipment and services. At CCA, your role matters. You'll be joining an organization that is mission driven, believes in internal mobility, has excellent benefits (see below) and embraces innovation when it comes to serving our patients.

  • Perform comprehensive annual assessments.
  • On an annual basis, conduct an Annual Comprehensive Assessments on assigned panel members using CMS guidelines.
  • Facilitate, and/or deliver preventative care to members according to the guidelines deemed appropriate by CCA Clinical Leadership.
  • Provide regularly scheduled follow up visits for the management of chronic disease or end of life/palliative care.
  • Perform episodic urgent medical/ behavioral health visits to ensure that panel members are given timely and appropriate medical care in order to avoid emergency room or hospitalization.
  • In order to decrease the risk of readmission, perform post-discharge visits on panel members within 48-hours of discharge; perform detailed medication reconciliation, adjust medications as indicated, and ensure appropriate LTSS are in place.
  • Provide Intermittent Skilled Care as necessary (e.g., wound care,)
  • Ensure appropriate documentation of visits and activities within CCA's central enrollee record and within the record of partners as indicated.
  • Develop a member-centric care plan which is inclusive of appropriate long-term support services and optimizes available resources to improve or maintain health and functional independence in the community.
  • Review care plan with the member and ensure that it is available to the member.
  • Utilizing Clinical Decision Support Tools, team meetings, and consultation with CCA specialists, authorize proposed equipment and/or services for the implementation of the individualized plan of care. Participate in utilization and case review as necessary.
  • Conduct annual/6 month MDS assessments and annual comprehensive assessments for panel members based on the program.
  • Act as a mentor to other team members to help promote/foster accountability, reliability, and independence among the other team members
  • Provide consultation and support to other members of CCA Care Team
  • Participate in Team Case Review
  • Participate in activities and education to maintain and advance competencyRequired
    • Bachelor's degree or equivalent experience
    • Board Certified Nurse Practitioner or Physician Assistant with licensure in good standing in the Commonwealth of Massachusetts
    • 3+ years of hands-on clinical experience
    • Will be required to pass CCA's credentialing process
    • Current Mass Controlled Substances License required
    • Current DEA Controlled Substances License required
    • Current CPR or Basic Life Support (BLS) Certification, requiredPreferred
      • Master's degree in Nursing or Physican Assistant Studies
      • 1+ years of NP or PA experience (preferably in primary care), strongly preferredDoes this sound like you? If you're interested in this opportunity, please apply today. The process takes 10-15 minutes. We offer excellent benefits, including: Medical, dental and vision plans with low employee contributionsA generous paid time off program403(b) with company matchLoan Forgiveness ProgramEducational Assistance/Reimbursement keywords: NP, Nurse Practitioner, PA, Physician Assistant, healthcare, primary care, clinic, care coordinator, care coordination, clincial, clinician, community health, social services, complex, medical, behavioral, bilingual, managed care, Springfield, MA, Massachusetts

Keywords: Commonwealth Care Alliance, Springfield , Advanced Practice Primary Care Clinician, Other , Springfield, Massachusetts

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