Assessment & Care Planning Nurse Practitioner (Fall River/Taunton)
Why This Role is Important to Us:
Commonwealth Care Alliance's (CCA) Assessment and Care Planning unit is primarily responsible to ensure adherence to high quality community-based assessments and member-centric care plans for CCA members.
The Assessment and Care Planning Nurse Practitioner conducts timely, high quality, accurate in-person annual comprehensive assessments and MDS assessments and documents person-centered care plan using data collected during the assessment process.
This individual works collaboratively with other members of the Assessment and Care Planning Unit and staff in other departments as needed to support timely intervention designed to improve outcomes of CCA members.
The Assessment and Care Planning Nurse Practitioners reports to the Regional NP Manager/SupervisorWhat You'll Be Doing:
Conduct in-person assessments on members who needs both the Annual Comprehensive Assessment and MDS Reassessments.
That include taking a detailed history, performing a physical examination, and documenting appropriate diagnosis in order to ensure capture of high-risk codes under CMS guidelines and Rating Category under MassHealth guidelines.
Perform 6month/annual MDS reassessments and annual comprehensive assessment based on program (every 6 months for SCO, annually for One Care) Risk adjustment- Performs and documents Annual Comprehensive Assessments ensuring that CCA is properly funded and quality, patient-centered care plan is provided.
Performs ongoing history.
Exam and medical decision-making including pharmacotherapy in collaboration with internal and external providers.
Manages assessment activities through calendar and tracks status of completion.
Participates in assessing and improving quality within the scope of responsibilities and throughout the organization Participates in activities and education to maintain and advance clinical competencies Seeks to maintain a constructive work environment and maintains effective communication with other employees and managers Maintains confidentiality of patient and employee information Complies with organization's policy and procedures.
Ensures immediate referral to any time-sensitive services such as Behavioral Health, Long Term services and Supports, or Rehab.
Communicate any time-sensitive concerns or clinical urgency to NP Manager/Supervisor during or immediately following visits.
Facilitate warm hand-off to the care partner if there is an immediate need that needs to be addressed.
At minimum of one day a week, The Per-Diem Assessment and Care Planning Nurse Practitioner conducts timely, high quality, accurate in-person combined annual wellness assessments and comprehensive assessments and documents person-centered care plan using data collected during the assessment process.
Provide clinical care to members via telehealth technologies (video, chat, etc.
) for a clinically appropriate clinical care and care management services.
Additional duties as requested by supervisor What We're Looking For:
RequiredBachelor's DegreePreferredMaster's degree in NursingRequired NP with active NP license in Commonwealth of Massachusetts, in good standing Preferred:
Additional NP license in Rhode Island 1
years' experience in home care and/or community settings preferred New Grads welcome Required Board Certified Nurse Practitioner with licensure in good standing in the Commonwealth of Massachusetts.
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.
Mass Controlled Substances License requiredwithin first 90 days DEA Controlled Substances License requiredwithin first 90 days Current CPR or Basic Life Support (BLS) Certification Willing to learn and utilize telehealth technologies (video, chat, etc.
), when appropriate, for a variety of clinical care and care management services.
EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/DisabledPlease note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
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.
Recommended Skills Assessments Basic Life Support Behavioral Medicine Cpr Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
Commonwealth Care Alliance's (CCA) Assessment and Care Planning unit is primarily responsible to ensure adherence to high quality community-based assessments and member-centric care plans for CCA members.
The Assessment and Care Planning Nurse Practitioner conducts timely, high quality, accurate in-person annual comprehensive assessments and MDS assessments and documents person-centered care plan using data collected during the assessment process.
This individual works collaboratively with other members of the Assessment and Care Planning Unit and staff in other departments as needed to support timely intervention designed to improve outcomes of CCA members.
The Assessment and Care Planning Nurse Practitioners reports to the Regional NP Manager/SupervisorWhat You'll Be Doing:
Conduct in-person assessments on members who needs both the Annual Comprehensive Assessment and MDS Reassessments.
That include taking a detailed history, performing a physical examination, and documenting appropriate diagnosis in order to ensure capture of high-risk codes under CMS guidelines and Rating Category under MassHealth guidelines.
Perform 6month/annual MDS reassessments and annual comprehensive assessment based on program (every 6 months for SCO, annually for One Care) Risk adjustment- Performs and documents Annual Comprehensive Assessments ensuring that CCA is properly funded and quality, patient-centered care plan is provided.
Performs ongoing history.
Exam and medical decision-making including pharmacotherapy in collaboration with internal and external providers.
Manages assessment activities through calendar and tracks status of completion.
Participates in assessing and improving quality within the scope of responsibilities and throughout the organization Participates in activities and education to maintain and advance clinical competencies Seeks to maintain a constructive work environment and maintains effective communication with other employees and managers Maintains confidentiality of patient and employee information Complies with organization's policy and procedures.
Ensures immediate referral to any time-sensitive services such as Behavioral Health, Long Term services and Supports, or Rehab.
Communicate any time-sensitive concerns or clinical urgency to NP Manager/Supervisor during or immediately following visits.
Facilitate warm hand-off to the care partner if there is an immediate need that needs to be addressed.
At minimum of one day a week, The Per-Diem Assessment and Care Planning Nurse Practitioner conducts timely, high quality, accurate in-person combined annual wellness assessments and comprehensive assessments and documents person-centered care plan using data collected during the assessment process.
Provide clinical care to members via telehealth technologies (video, chat, etc.
) for a clinically appropriate clinical care and care management services.
Additional duties as requested by supervisor What We're Looking For:
RequiredBachelor's DegreePreferredMaster's degree in NursingRequired NP with active NP license in Commonwealth of Massachusetts, in good standing Preferred:
Additional NP license in Rhode Island 1
years' experience in home care and/or community settings preferred New Grads welcome Required Board Certified Nurse Practitioner with licensure in good standing in the Commonwealth of Massachusetts.
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.
Mass Controlled Substances License requiredwithin first 90 days DEA Controlled Substances License requiredwithin first 90 days Current CPR or Basic Life Support (BLS) Certification Willing to learn and utilize telehealth technologies (video, chat, etc.
), when appropriate, for a variety of clinical care and care management services.
EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/DisabledPlease note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
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.
Recommended Skills Assessments Basic Life Support Behavioral Medicine Cpr Certified Nurse Practitioner Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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