Nursing Jobs in Needham, MA
$58,656 - $142,448.80 / year
Site: Mass General Brigham Community Physicians, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Across the country, governments, employers, and American families have struggled in the face of rising healthcare costs. Efforts historically have targeted narrow programs and patient populations, and while many have succeeded, healthcare costs continue to rise. It’s time to take a radically different approach. A new approach involves putting the patient at the center with the goals of improving value and providing better outcomes at lower cost for patients. The Population Health Management (PHM) department at Mass General Brigham is charged with the challenge to drive better value for patients across Mass General Brigham. To achieve its goals, PHM leverages financial and clinical data to examine opportunities, designs and delivers innovative care models using product development and design thinking disciplines, and leverages problem solving, teamwork, and leadership skills to drive ongoing improvement. As an integral member of the Population Health Management Operations team, The Transition of Care Nurse Care Manager provides episodic care management for Medicare Shared Savings Program (MSSP) and Medicaid ACO patients from inpatient admission to home. This includes follow up phone calls after discharge, medication reconciliation, and ensuring patient has appropriate follow up appointments scheduled as well as documenting and ensuring all billing requirements are met prior to submitting TCM charges. The Transition of Care Nurse Manager directly interfaces with patients (via phone), Primary Care physicians, pharmacists, care managers, and health care teams involved in patient care as well collaborating with PHM Clinical Operations leadership. Primary Responsibilities: 1. Manages episodic transitions of care for Medicare Risk and Medicaid risk patients from inpatient discharge to home as applicable. a. Calls all discharged patients within two business days of discharge and conducts post discharge assessments. b. Works alongside the PHM Clinical Pharmacist to identify and perform Medication Reconciliation for identified patients within the two day follow up phone call. c. Reviews discharge instructions/paperwork prior to call to review with patient any action items needed prior to follow up appointment. d. Facilitate face to face follow-up appointment with their PCP within 7-14 days after discharge (or according to discharge instructions if applicable). e. Document patient interaction (phone calls) in the appropriate patient chart in the electronic medical record. f. Manages and coordinates transitions of care by communicating the care plan to other providers and care managers and applicable practice staff. g. Maintains all documentation according to standards and requirements. h. Ensures all Transitions of Care (TCMs) meet appropriate billing requirements prior to submitting documentation to the billing department per protocol yet TBD. 2. Demonstrates effective teamwork and collaboration with the primary care provider and the care team a. Engages the patient and caregiver as active members of the care team and facilitates an organized and effective, warm hand off for transitions of care back to the patient's medical home (PCP). b. Participates in regular meetings with the providers and the care team to identify opportunities for better transitions or to modify workflows as needed. c. Communicates with other PHM and (Regional Service Operation (RSO) departments and sites to foster collaboration as a 'system' around the patients served. Organizational Responsibilities: 1. Demonstrates a positive attitude in dealing with patients, co-workers, and other health care providers and in addressing problems and/or crisis situations. 2. Requires the ability to work independently as well as function effectively within a team-based model of care. 3. Able to establish collegial relationships with physicians, office staff and health care providers in physician's offices, community agencies, hospitals, and other health care facilities. 4. Functioning within the patient centered model of care, demonstrates a commitment to meeting the patient’s needs and expectations. 5. Functioning within the team-based model of care 6. Demonstrates initiative and creativity to continuously improve services, work processes, and other activities that affect quality and utilization. 7. Follows applicable policies and procedures for general safety, fire safety, infection control, attendance, punctuality, and appearance. 8. Performs all duties as assigned. Other Duties and Responsibilities: 1. Assumes accountability for professional growth and development. 2. Acts as a role model for patients by practicing behaviors consistent with the program goals of health promotion and disease prevention. 3. Identifies quality of care issues and reports the concerns to the appropriate person. 4. Collects, prepares, and reports data as directed. 5. Assists in preparation for external audits and surveys as applicable. Qualifications Qualifications Required: Associate’s Degree Nursing (ASN) or Bachelor’s Degree Nursing (BSN). RN License for State of MA. 3+ years of experience in hospital, health plan or community case management or utilization management role. Care management or home care background. Managed Care or previous healthcare reimbursement knowledge. Preferred: Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. Certification in Case Management (CCM) and/or other applicable professional certification preferred. Previous experience working in a post-acute setting such as LTAC, acute rehabilitation, skilled nursing facility, or homecare. Bedside nursing experience. Additional Skills, Knowledge and Abilities: - Excellent organizational skills. - Excellent oral, written, and telephonic skills and abilities. - Critical thinking and problem-solving ability. - Demonstrated ability to present and speak in front of groups. -Demonstrated competency working with health care setting computer systems. -Competence in Microsoft Word, Excel and PowerPoint. -Ability to work effectively with physicians and their staff in a physician practice setting. -Ability to work a flexible schedule including some required evenings or early mornings. -Knowledge of levels of care and the continuum of health care services. -Ability to handle routine work, unexpected priorities, and multi-task. -Requires autonomy in decision making using sound judgment based upon factual information, clinical experience and nursing process. -Ability to work with various practice sites. Additional Job Details (if applicable) Schedule and Work Model Full-Time Saturday through Wednesday, standard business hours (approximately 8:30am-5pm ET), with some flexibility with hours on weekends. Remote with ability to travel to Assembly Row in Somerville, MA for team building, best practice sharing meetings and/or events. As a remote employee, must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $58,656.00 - $142,448.80/Annual Grade 98TEMP At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 6010 Mass General Brigham Community Physicians, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. 
$107,000 - $224,123 / year
If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-23332 Facility: LOC0010 - Health Express-Weymouth330 Washington Street Weymouth, MA 02188 Department Name: HXP Administration Status: Part time Budgeted Hours: 0 Shift: Varied Shifts (United States of America) Under the general guidance of the Hospitalist Director the Nurse Practitioner will evaluate, diagnose and treat patients following written guidelines approved by the Department of Medicine. As a Hospital Medicine Provider at SSH, you will report, through the Hospitalist Program leadership team including the Lead APC’s and Program Director. You will have such duties and responsibilities as are set forth below and as may be reasonably requested by SSH from time to time. You shall perform the medical services faithfully, with due diligence and efficiency, to the best of your ability, and in accordance with the applicable standards of your profession, canons of professional ethics and all laws and SSH policies in effect from time to time. SSH recognizes that teamwork and flexibility are essential to providing 24-hour per day patient-centered care. SSH expects you to be respectful of your patients, other health care providers, and the physicians and staff of SSH. You shall be professional at all times and adhere to HIPAA standards with regard to maintaining confidentiality of patient information. You will have several different roles as a SSH Hospital Medicine Provider. These roles include admitting, rounding, and performing consults at the request of other providers. Regardless of role, you will be required to use approved SSH patient care treatment plans and order sets, when appropriate. Compensation Pay Range: $107,000.00 - $224,123.00 Essential Functions: Obtains a detailed and accurate medical history and performs a comprehensive physical exam for patients admitted to the Hospital. Orders necessary diagnostic tests, consultations and procedures as indicated or requested by the Hospital Medicine Consultant or attending physician. Identifies and manages chronic medical conditions and provides continuous care to hospitalized inpatients. Has familiarity with current guidelines regarding the assessment of the risk of a perioperative cardiovascular event for pre-operative patients (such as RCRI, and ACS-NSQIP) and pre-operative medical optimization. Prescribes medications, as necessary. Writes orders in accordance with current practice guidelines. Writes complete and comprehensive notes on all patients using appropriate electronic systems consistent with Hospital policy. Facilitates timely care, as necessary. Actively participates in the South Shore Health System readmission reduction efforts. Reviews the care of each patient with the attending physician and other consultative services. Maintains communications with referring physicians. Collaborates with the patient care team (physicians, nurses, PT/OT, case management) to develop and facilitate care plan. Proactively manages patients to prevent complications. Provides urgent evaluation to patients with changes in clinical status. Prepares patients for discharge, including patient and family discharge teaching, continuing care and rehabilitation arrangements in conjunction with Nursing and Care Progression, writing discharge prescriptions, and confirming primary care or referring physician follow-up. Prepares formal discharge summaries for or with Hospitalist. Possess the maturity, self-confidence, and ability to follow complex patient management plans as directed by the attending physician. Eligible for state and federally controlled substances registration. Demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his/her assigned unit. Time Management: Exceptional organizational skills and ability to organize time and priorities effectively, asking for direction when appropriate. Flexibility to handle multiple tasks and deadline pressures. Quality Improvement: Skills to work efficiently and effectively and strive to do so in all aspects of position. JOB REQUIREMENTS Minimum Education - This position is a licensed independent practitioner credentialed through the Medical Staff Services Office Completion of Advanced Physician Assistant or Nurse Practitioner training program from an accredited institution. All licensure re-certifications, as required. Minimum Work Experience 2 years of Acute Medicine experience, preferred. Required Licenses / Registrations Nurse Practitioner - Board of Registration in Nursing (Massachusetts) Required Classes/Skills - ACLS - Advanced Cardiac Life Support Required additional Knowledge, and Abilities Requires DEAx number for the ability to prescribe Buprenorphine/Suboxone Demonstrated history of proficiency in the delivery of medical care to adult patients. Demonstrated successful completion of the SSH Credentialing process. Hours M-F 9am - 7pm; Sat-Sun 9am - 4pm Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: ACLS (AHA) Advanced Cardiac Life Support Certification - American Heart Association (AHA) (Including courses offered through SSH), Certified Nurse Practitioner - Board of Registration in Nursing (Massachusetts) 