Commonwealth Care Alliance Job Details: Advanced Practice Clinician, Unpanelled in Boston, Massachusetts

Job Details: Advanced Practice Clinician, Unpanelled

On-Line Application

  • Vacancy NoVN1436

Posting TitleAdvanced Practice Clinician, Unpanelled

Location CityBoston

Language Requirement

Job Description

Organization Overview

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.

Position Summary

Commonwealth Community Care’s (CCC) unpanelled clinician is primarily responsible for providing short-term in-person episodic care and care management to a flexible panel of dually-eligible or FFS members, a group of individuals with significant medical, behavioral, and social complexities that require intensive clinical support.

The need for the Unpanelled APC is triggered by an acute event or significant change in condition of a member which necessitates close, short term follow up by an Advanced Practice Clinician.

The Unpaneled APC will provide short term, episodic chronic disease management, make urgent visits, promote preventative care and wellness, and provide end of life/palliative care. The role also includes performing a discrete set of care management/care coordination functions, including the adjustment of the member centric care plan and authorization of appropriate durable medical equipment and services.

Key Responsibilities

  • Performs episodic urgent medical/ behavioral health visits to ensure that members are given timely and appropriate medical care in order to avoid emergency room or hospitalization.

  • Facilitates and/or delivers preventative care to members according the guidelines deemed appropriate by CCC Clinical Leadership. Guidelines may vary based on the individual make-up of the member and is based on age, comorbidities, etc.

  • Identifies and initiates a plan to resolve areas of opportunity to meet quality metrics.

  • Provides limited regularly scheduled follow up visits for the management of chronic disease or end of life/palliative care.

  • In order to decrease risk of readmission, performs post discharge visits on members within 48-hours of discharge from either an acute care facility or a skilled nursing facility; performs detailed medication reconciliation, adjust medications as indicated, and ensure appropriate LTSS are in place. May follow recently discharged members for up to 30 days for disease management stabilization.

  • Liaises with CCC Care Partner and Specialists, as needed

  • Provides Intermittent Skilled Care as necessary (e.g., wound care,)

  • Documents all activities and results using an Electronic Medical Record, in an effective manner while strictly adhering to CCA policies and procedures

  • Adjusts the member centered plan of care as necessary based on a significant change in condition. A change in condition is an event (hospitalization, acute illness, etc.) which results in either a short or long term change in need (examples include adding in Palliative care, increasing personal care hours short term post hospitalization, or purchasing high cost durable medical equipment for a non-reversible functional change)

  • Provide short term coverage when required for vacated panels due to leaves of absence.

  • Participates in weekend and overnight on-call.

Education Requirements

  • Master’s degree in Nursing or PA degree

Experience Requirements

  • 3-5 years of hands on experience

  • Graduation for an accredited NP or PA program

  • ANCC or AANP certification for NPs and NCCPA certification for PAs

  • Licensure to practice in the state of MA

  • Mass Controlled Substance Registration

  • DEA Registration

  • Current BLS for Healthcare Providers Certification

  • Relevant work or education-related clinical experience required.

Knowledge, Skills and Abilities

  • Proven skills and knowledge necessary for independent clinical decision making at the NP/PA level

  • Must have strong primary care skills. Proficient in taking medical history, performing physical exam and assessment, determining differential diagnosis based on symptoms and exam findings, ordering and interpreting laboratory and diagnostic tests, and utilizing clinical judgment to determine appropriate treatment plan.

  • Must be comfortable working with patients who have behavioral health diagnoses; psychiatric disorders, substance abuse or addictions

  • Makes independent clinical decisions daily that affects clinical and financial outcomes while utilizing Clinical Decision Support Tools

  • Collaborates with administrative, clinical and medical leadership on decisions that are not directly related to patient care

  • Decision making involves diagnosing, treating and prescribing medications and medical therapeutics. Decisions around assessment and testing, ethical dilemas, complex clinical situations and service needs are made in conjunction with the clinical team and with reference to CCA’s Clinical Decision Support Tools.

  • Complexity of this role is advanced

  • On a daily basis, makes independent and collaborative medical decision on complex patients in a fast-paced and constantly evolving work environment

Working Conditions

  • CCA serves a high-risk patient population which is medically/socially and behaviorally complex. Clinicians see members in the community: in homes, group homes, shelters, primary care clinics, assisted living facilities and hospitals. It involves constant travel within CCA’s service area.

  • Must be able to drive with an unencumbered license

  • Must be proficient in the use of stethoscope, sphygmomanometer, pulse oximeter, otoscope, ophthalmoscope.

  • Must be able to self-identify learning needs for equipment that may not be a part of everyday use: glucometer, Coagu-Check, phlebotomy supplies, catheterization supplies, wound care supplies and equipment, updraft equipment, inhalers and spacers, and other member-specific supplies and equipment, as appropriate.

  • Standard Office equipment

Language Requirements

  • Ability to communicate fluently in a language other than English is a plus. Languages commonly spoken by CCA’s patient population include Spanish, Portuguese, Haitian Creole, Vietnamese, Hindi.

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