Master's degree from an accredited Nurse Practitioners program required.
Licensed by the Commonwealth of Massachusetts Board of Registration in Nursing.
Must possess a valid driver's license and reliable transportation.
1-3 years of Nurse Practitioner experience preferred, particularly in geriatric care.
Experience in healthcare settings as part of a clinical team.
Responsibilities
Perform post-enrollment visits and biannual exams, documenting issues in medical records.
Evaluate and manage episodic illnesses with appropriate diagnostic and therapeutic orders.
Collaborate with interdisciplinary team members to address chronic medical needs.
Conduct and document Advance Directives/MOLST discussions at least annually or with changes in condition.
Implement participant plans of care in a safe and effective manner.
Maintain accurate documentation and coding for all services rendered.
Provide education and training to participants and caregivers in relevant topics.
Benefits
Continuity of care models emphasizing person-centered approaches.
Collaborative work environment within an interdisciplinary team.
Opportunities for professional growth and development through educational programs.
Involvement in quality assessment activities and policy revisions.
Participation in committees and professional activities for personal development.
Full Job Description
Overview
Brief summary of purpose:
Manages a primary care panel of participants and provides continuity primary health care to PACE participants that reside in the community or long-term care setting with a focus on goal oriented, person-centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant's goals of care. Works in close collaboration with all members of the PACE Interdisciplinary Team.
Establishes realistic goals and helps develop and manage individualized plans of care with the IDT team for program participants.
Provides primary health care to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness. Addresses advance directives in a participant-focused manner focusing on what matters most.
Works in close collaboration with the program's interdisciplinary team to establish realistic goals and care plans and develop and manage individualized plans of care for program participants.
Responsibilities
Primary Job Responsibilities (include duties that represent 5% or more of employee's time)
Performs post enrollment visits, biannual exams of participants and appropriately identifies and documents problems/issues in medical records
Evaluates episodic illnesses and issues appropriate diagnostic and therapeutic orders
Collaborates with physicians and other interdisciplinary team members to manage episodic and chronic medical needs of participants
Addresses and documents Advance Directives/MOLST discussion for participants a minimum of annually and when a change in participant condition occurs
Performs diagnostic, therapeutic and nursing intervention as indicated
Provides continuity in monitoring of chronic, stable illnesses
Implements the participant plan of care in a safe and effective manner
Participates in interdisciplinary team meetings
Evaluates effectiveness of previously implemented treatment
Conducts home and nursing home visits as indicated
Maintains accurate documentation and coding of all services provided according to professional standards
Identifies utilization and service delivery problems and participates in identifying a resolution
Identifies grievances and brings forward to leadership
Participates in quality assessment activities including but not limited to record reviews, outcome measurement and review/revision of policies and procedures
Provides education and training to participants, caregivers and staff in relevant topics
Acts a resource to program staff and participates in defining care standards and practices
Serves on appropriate committees, participates in all site and provider staff meetings including behavioral rounds and psychiatric rounds as indicated.
Enhances personal professional growth and self-development through participation in professional activities including educational programs, current literature, in-service programs, trainings and workshops.
Maintains BLS certification and professional certification as appropriate.
May be asked to perform other duties that align with Fallon Health's mission, including but not limited to participation on clinical committees, providing education, quality initiatives and/or other activities.
Qualifications
Education:
Master's degree required. Graduate of an accredited Nurse Practioners program
License/Certifications:
Licensed by the Commonwealth of Massachusetts Board of Registration in Nursing.
Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:
Must possess a valid drivers' license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation
Experience:
One to three years of Nurse Practitioner experience preferred with at least one year of experience in geriatric care.
Experience working in a healthcare setting as a member of a professional clinical team.
Experience with care coordination.
Other: Satisfactory Criminal Offender Record Information (CORI) results
Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is budgeted between $150,000 - $170,000 per year which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.
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About Fallon Health
Fallon Health is a non-profit health care services organization that provides health care services designed to meet the unique and changing needs of all we serve. We are committed to providing our members with the highest quality health care products and services, while also providing our employees with a supportive and rewarding work environment. Our mission is to improve the health and well-being of our communities by providing innovative, high-quality, and affordable health care services.
