Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package
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, psychopharmocotherapy and health education in collaboration with PCPs and CCA clinical specialists as needed.
• Professionalism – Exhibits professionalism and the translation of CCA’s 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 member’s biopsychosocial condition.
• 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.
Minimum Education Required: Master’s degree in Nursing or PA degree
Minimum Years Experience Required 3 years