Senior Direct Care Practitioner, Bilingual Preferred

🔥 10 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $121.3k - $182k / year

⏰ Full Time

🟠 Senior

💬 Bilingual

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Point32Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Point32Health is a leading nonprofit health and well-being organization that provides health coverage and services for individuals at all life stages. Through its family of companies, including Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health offers a variety of health plans, programs, and services encompassing medical, pharmacy, wellness, and behavioral health. Point32Health is committed to health equity and has been recognized for its inclusive practices, earning distinctions in areas such as health equity, disability inclusion, and LGBTQ+ workplace inclusion. With a focus on innovative solutions and high-quality coverage, Point32Health strives to create a better healthcare experience for its members and communities.

📋 Description

• Performs comprehensive clinical exam and assessment upon admission • Meets with facility staff and identifies the goal of the SNF stay • Formulates discharge plan through discussion with multidisciplinary team with a focus on attainable goals and identified barriers • Assess the patient at each visit to determine clinical status and progress towards goals • Collaborates and communicates with members of the care team to establish expected length of stay, goals of stay and level of care. • Serves as a resource for family, member, and case management teams to establish a mutually agreed upon discharge plan that is safe and attainable. • Works collaboratively with all community case management teams and supports to optimize high risk discharge planning and care coordination • Serves as a constant resource for the family and member • Establishes collaborative relationships with supervising and collaborating physician groups and determines communication preferences between NP and receiving MD. • ANP will provide primary care to long term care population in designated facilities where applicable • Expected to see monthly as well as when there is a change in status with a focus on treat in place conditions • Serves as a resource of the families, members, and staff • Experienced and skilled with end of life and goals of care discussions through care continuum as well as competent with Molst form completion and counseling • Performs annual comprehensive exams on all eligible members assigned in applicable facilities and geographies • Knowledgeable with regards to risk adjustment coding and apply these concepts appropriately • Strong communication with all clinical teams including case management as it relates to issues identified during the assessment and recommendations that will overall benefit health and wellness trajectories • Collaborate with all key stakeholders including primary care providers and case management teams with a goal to improve preventive care, eliminate crucial care gaps and improve the overall care experience • Accountable to performance metrics that are outcome, quality and productivity based

🎯 Requirements

• Certified nurse practitioner through ANCC/AANP for adult, family, acute care, and/or geriatrics (GNP preferred) • Current Massachusetts State license • Current Drug Enforcement Administration (DEA) registration • Current Massachusetts Department of Public Health (DPH) Controlled Substance Registration (CSR) • Graduate degree from an accredited school of nursing and nurse practitioner program. • 2 years of experience working with the frail or elderly population. • Experience with computer systems, including web-based applications, electronic medical records, and some Microsoft Office applications (Word, Excel) • SNF experience; minimum two years of experience in primary care of the older adult as well as experience in nursing facility care preferred; Medicare and Medicaid experience preferred • Strong communication and human relationship skills are required to work with a variety of medical, nursing, and allied health personnel as well as with patients and their families. • Ability to exercise clinical and professional judgment and raise issues appropriately • Strong attention to detail • Experience with motivational interviewing and/or health coaching a plus. • Ability to speak clearly, see and hear individuals.

🏖️ Benefits

• Medical, dental and vision coverage • Retirement plans • Paid time off • Employer-paid life and disability insurance with additional buy-up coverage options • Tuition program • Well-being benefits • Full suite of benefits to support career development, individual & family health, and financial health