Landmark Health Physician Assistant - Urgent Visit in Boston, Massachusetts
This role primarily provides medical care and management to members served by the Landmark program who request urgent visits to the NCM on call from 8:00 AM to 5:00 PM Monday – Friday (Non-Holiday). This position also participates in gathering clinical information for medical necessity determinations for service requests. Works with the Landmark Regional Medical Director, Director of Health Services, and IDT staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs. Dedicated to improving the health and well-being of members, this position collaborates with the PCP, and as needed, the health plan Medical Director and other health professionals, to develop members’ goals of care in all phases of long-term care.
Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing.
Working with the NCM schedules patients for maintenance visits in a way and volume that allows prompt response to urgent patient requests during normal business hours.
Following the visit promptly communicates with the PCP and specialist as needed along with communicating findings to their primary assigned Landmark provider.
Completes the required documentation in a timely manner (goal <48 hours) allowing the care team a access to the care provided and a note to be generated to the PCP.
Understands and complies with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communities.
Establishes and maintains effective relationships with members and their legal representatives, facility staff, PCPs and other collaborating physicians/providers.
Performs an initial comprehensive assessment on all newly enrolled members and at least bi-annually thereafter. Develops a member management care plan upon enrollment and updates it as needed when changes in condition warrant or following hospitalization. Meets with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in these meetings.
Completes follow-up and post-hospital assessments according to documented standard operating procedure.
Prescribes appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissions.
Consults with hospital physicians following notification of member transfer.
Collaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical services.
Educates members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellness.
Provides counsel, support and education to facility staff.
Supports FCMs in developing and providing in-service educational programs to facility staff.
Participates in management meetings that include, but may not be limited to:
Weekly case conference reviews
Monthly staff meetings
Schedule Joint Operating Committee meetings
Quarterly Quality Improvement Committee meetings
Continuing education/journal club programs
Implements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and delivery.
On-call for caseload during business hours. May require some participation in clinical on-call program as plan expands.
Keeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviews.
Perform related duties as necessary and other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Completion of Physician Assistant accredited program
Minimum of two (2) years clinical experience, desired
Knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systems
Knowledge of CPT, ICD-9 and HCPC codes
Knowledge of clinical standards of care
Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems is helpful
Job ID: 2018-2186
External Company Name: Landmark Health