Commonwealth Care Alliance Job Details: Primary Care Nurse Practitioner in Charlestown, Massachusetts
Job Details: Primary Care Nurse Practitioner
- Vacancy NoVN1361
Posting TitlePrimary Care Nurse Practitioner
Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
Care Partner, NP
Commonwealth Care Alliance’s (CCA) Care Partner Team is primarily responsible for providing longitudinal care coordination, care management, and/or care delivery to a dedicated panel of dually-eligible CCA members, a group of individuals with significant medical, behavioral, and social complexities that require intensive clinical support.
The NP, Care Partner (Mobile) will provide ongoing chronic disease management, urgent visits, promote preventative care and wellness, and provide end of life/palliative care. 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.
• Within a defined time period post assignment, perform a comprehensive annual assessment taking a detailed history, performing a physical examination, and documenting appropriate diagnosis with a plan to address unmet needs associated with the diagnosis. The onboarding Annual Comprehensive Assessment also ensure capturing appropriate High Risk Codes under CMS guidelines
• On an annual basis, conduct an Annual Comprehensive Assessments on assigned panel members, taking a detailed history, performing a physical examination, and documenting appropriate diagnosis in order to ensure capture of high risk codes under CMS guidelines.
• Facilitate, and/or deliver preventative care to members according the the guidelines deemed appropriate by CCA Clinical Leadership. Guidelines may vary based on the individual make up of the member and is based on age, co morbidities ,etc. Identify and initiate a plan to resolve areas of opportunity to meet quality metrics.
• Provide regularly scheduled follow up visits for the management of chronic disease or end of life/palliative care. Visits are inclusive of a history of present illness, review of systems, physical exam, ordering of appropriate studies and tests, identification of a definitive diagnosis, adjustment or maintenance of an established treatment plan, and consistent follow up of the plan as evidenced in the documentation.
• 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. Visit includes a detailed history of present illness, review of systems, physical exam, ordering of appropriate studies and tests, identification of a definitive diagnosis, development of a treatment plan, and evidence of follow up through timely documentation.
Master’s Degree – Current NP License for MA
Minimum of 3 years experience
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws