The Advanced Practice Clinician II (APC) provides ongoing comprehensive home-based primary care and care management services to CCA members in collaboration with the patients PCPs and the rest of the CCA Primary Care Team which may include CCA RNs, LPNs, Medical Assistants, BH and Rehab specialists etc. Acts as consultant and mentor to other CCA team members which may include RN, LPN, MA, GSSC, LTSC, HOWs. + Primary care to members Provides patient-centered, comprehensive home-based primary care to complex adult and geriatric patients (assessment, diagnosis, treatment, referrals) to promote continuity of care by coordinating with PCP and other providers as necessary. + Specialty care to members Provides urgent/sick/episodic care, post-hospital care and palliative care. Coordinates other specialty services such as behavioral health, psychopharmacotherapy and health education in collaboration with PCPs and CCA clinical specialists as needed. + Professionalism Exhibits professionalism and the translation of CCAs mission into patient-centered activities and plans of care. + Risk adjustment Performs and documents Annual Comprehensive Assessments on a panel of members ensuring that CCA is properly funded and quality, patient-centered care is provided. Performs ongoing history, exam and medical decision making including pharmacotherapy in collaboration with internal and external providers. + On call Provides all services listed above on weekends and holidays, including making visits as needed, in an on-call rotation with NP/PA and RN colleagues. + Clinical documentation Provide expert-level comprehensive documentation in the clinical record to reflect the true complexity of each members biopsychosocial condition. + Continuing education Participates in ongoing educational activities and formal CME/CEU courses to advance knowledge base and skills competency and to maintain required licensure and certification. + Quality Assurance Ensures that clinical service delivery meets CCA standards as outlined in policies and standing operating procedures. Reviews quality metrics and develops plans to address deficiencies or substandard outcomes accordingly. + Teamwork Works effectively and collaboratively with colleagues to ensure satisfactory patient outcomes and maintains patient panel in collaboration with RN co-care manager. + Leadership Provides consulting and mentoring to new clinicians and CCA Primary Care Teams. Models professionalism and the translation of CCA's mission into patient-centered activities and plans of care. + Autonomy Works effectively and independently to problem solve. Uses appropriate time management and offers flexibility in team setting. Takes ownership of clinical decisions and offers consultation and guidance to peers. Offers constructive solutions to problems and is able to make clinical suggestions for further patient care. + Skills Building Has willingness to learn new and develop existing clinical skills, including a broad range of nursing tasks. Provides positive and constructive feedback for workflow processes. + 3-5 years meaningful clinical experience in primary, geriatric or critical care management. + Masters degree in nursing required. + Board Certified NP or Physician Assistant with licensure in good standing in the Commonwealth of Massachusetts, required. + Licensure to practice in the state of MA. + Mass Controlled Substance Registration. + DEA Registration. + Current BLS for Healthcare Providers Certification. + 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. + Ability to make independent clinical decisions daily that affects clinical and financial outcomes while utilizing Clinical Decision Support Tools. + Decision making involves diagnosing, treating and prescribing medications and medical therapeutics. + Decisions around assessment and testing, ethical dilemmas, complex clinical situations and service needs are made in conjunction with the clinical team and with reference to CCA's Clinical Support Decision Support Tools. #LI-AG1 ID: 2019-2190 External Company Name: Commonwealth Care Alliance, Inc. External Company URL: ommonwealthcarealliance.org/ Street: 101 Wason Avenue, 3rd floor
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.