Advanced Practice Provider
Job at a glance
Job description
The Advanced Practice Provider (APP – NP/PA) functions as a core clinical provider and interdisciplinary team member within the Element Care PACE Program, delivering comprehensive, participant-centered primary and geriatric care to frail, nursing-home-eligible older adults. This position is not traditional office-based primary care. The APP must demonstrate comfort with medical complexity, home-based care, urgent clinical decision-making, and care coordination within the PACE model.
Job Responsibilities
• Provide primary & episodic care for acute or chronic conditions across care settings (PACE center, home, ALF, SNF)
• Perform post-hospitalization follow-up & transitional care management
• Make nursing home visits in accordance with state and facility requirements
• Manage multiple chronic conditions using evidence-based geriatric principles
• Optimize medication regimens, address polypharmacy, & coordinate deprescribing when appropriate
• Identify & manage geriatric syndromes including falls, delirium, dementia, depression, incontinence, frailty, & functional decline
• Screen for depression, anxiety, substance use, & cognitive impairment
• Prescribe and monitor psychotropic medications within scope & collaborative agreements
• Recognize behavioral symptoms related to dementia & coordinate appropriate interventions
• Initiate & maintain advance care planning conversations aligned with participant goals and values
• Assess decision-making capacity & involve healthcare proxies as appropriate
• Complete & review advance directives forms in accordance with state regulations
• Collaborate with hospice & palliative care services when indicated
• Evaluate & manage urgent clinical issues to prevent avoidable ER visits and hospitalizations
• Exercise sound clinical judgment regarding escalation of care
• Actively participate in Interdisciplinary Team (IDT) meetings & care planning
• Communicate participant status and clinical recommendations clearly to team members
• Provide education to participants, families, caregivers, & staff
• Complete accurate, timely, and thorough clinical documentation onsite & offsite
• Adhere to Element Care policies, PACE regulations, and collaborative practice agreements
• Practice in a fiscally responsible manner within established budgetary guidelines
• Participate in quality improvement, peer review, and performance initiatives
• Perform other duties as assigned
Qualifications
• Current Board Certification as a Nurse Practitioner or Physician Assistant in the Commonwealth of Massachusetts.
• Massachusetts and DEA Prescription Privileges.
• Credentialed for the Element Care affiliate Long Term Care Facilities.
• Current CPR Certification.
• Minimum of 2 years working with a geriatric population.
• Frequent local travel.
• Ability to lead independently and to be able to work well with others.
• Ability to work within a team concept and to be considerate of co-workers and colleagues.
• Ability to pay attention to detail, to be a self-starter, and to complete tasks on time.
• Ability to be able to quickly recognize situations/problems before they become acute, and to be able to implement effective solutions and understand consequences.
• COVID vaccinated preferred.