Job Description

That’s Right!.. Fantastic work setting working in an elder adult day setting –

• Practical Monday to Friday Work week!
• Predictable 8:00 to 5:00 Day Shift!
• No Nights, No Weekends, No On-Call!
• Quality over Quantity Care Setting!
• Great Mentoring with Physicians and Opportunities to Work with Students!
• PACE is a Growing Area of Health Care, Come Grow with It!

About us:

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique. 

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region. 

Summary:

Manages a primary care panel of participants and provides continuity primary health care to PACE participants that reside in the community or long-term care setting with a focus on goal oriented, person-centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant’s goals of care. Works in close collaboration with all members of the PACE Interdisciplinary Team.

Establishes realistic goals and helps develop and manage individualized plans of care with the IDT team for program participants.

Provides primary health care to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness. Addresses advance directives in a participant-focused manner focusing on what matters most.

Works in close collaboration with the program’s interdisciplinary team to establish realistic goals and care plans and develop and manage individualized plans of care for program participants.

Brief Summary of Purpose: 

Serves as a float Nurse Practitioner to each of the Summit ElderCare sites with assignment based on business need. In this role, provides primary health care to Summit ElderCare program participants focusing on disease prevention, wellness and management of chronic and episodic illness in collaboration with the program’s Primary Care Providers. Works in close collaboration with the program multi-disciplinary team to establish realistic goals and develop and manage individualized plans of care for program participants. The role may involve working with Community based Physicians who are enrolling participants in the PACE program through the Community-based Physician waiver.

R esponsibility Summary: 

• Performs initial and periodic assessments of participants and appropriately identifies and documents problems/issues in medical
• Evaluates episodic illnesses and issues appropriate diagnostic and therapeutic
• Collaborates with physicians and other multi-disciplinary team members to manage episodic and chronic medical needs of
• Performs diagnostic, therapeutic and nursing interventions as
• Performs routine monitoring of chronic, stable
• Implements plans of care in a safe and effective
• Participates in multi-disciplinary team
• Evaluates effectiveness of previously implemented
• Conducts home and nursing home visits as
• Facilitates the continuum of care for sub-acute and long-term nursing home residents as indicated
• Maintains precise, accurate documentation of all services provided according to professional
• Identifies utilization and service delivery problems and participates in their
• Participates in quality assessment activities including but not limited to record reviews, outcome measurement, and review/revision of policies and
• Provides education and training to participants, caregivers and staff in relevant
• Acts as a resource to program staff and participates in defining nursing standards and
• Serves on appropriate committees; participates in staff
• Enhances professional growth and self-development through participation in research activities, other professional activities, educational programs, current literature, in-service programs and
• Maintains BLS certification and professional certification as
• Has responsibility as a full member of the Summit ElderCare Department of
• Provides on call coverage for the Summit ElderCare program on an as-needed basis or as assigned by the Medical
• Supports the fundamental mission of the PACE

Education:

• Master’s degree required. Graduate of an accredited Nurse Practitioner program

License/Certifications: 

• Licensed by the Commonwealth of Massachusetts Board of Registration in Nursing. Valid driver’s license and clean driving record required.
• National Board Certification as a Geriatric, Adult, or Family Nurse Practitioner.

Experience: 

• One to three years of Nurse Practitioner experience preferred with at least one year of experience in geriatric care.
• Demonstrates a broad knowledge of medical conditions and appropriate interventions.
• Able to apply the principles, methods and techniques of professional nursing practice to the care of program participants.
• Able to establish and maintain effective working relationships with program participants, family caregivers, medical staff and program staff.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

PId2857fdce5cc-30492-38011203

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