Geriatric Nurse Specialist (LPN/RN) – Primary Care & Care Coordination
On-siteBoston, Massachusetts, United States
Job Summary
Conduct comprehensive geriatric assessments, including functional status, cognitive health, and home safety evaluations, while preparing for and supporting Medicare Annual Wellness Visits. Coordinate patient follow-up care, arrange preventive screenings, and facilitate advance care planning discussions with patients and families. Perform medication reconciliation during visits and educate caregivers on high-risk medication use. Provide ongoing care coordination for high-risk older adults across primary care practices, patient homes, and senior living facilities by conducting home visits and collaborating with physicians and community partners. Ensure seamless transitions of care and monitor high-risk residents to improve quality outcomes.
Required Qualifications
- Licensed Practical Nurse (LPN) or Registered Nurse (RN)
- Current unrestricted MA license and the ability to obtain or maintain NH licensure
- 10+ years of experience caring for geriatric patients
- Strong clinical knowledge of chronic disease management, medication reconciliation, care transitions, and patient education for older adults
- Excellent communication skills with the ability to work independently and collaborate effectively within an interdisciplinary team
- Valid driver's license and reliable transportation
- Ability to lift up to 25 pounds and safely walk, stand, bend, navigate residential environments, and perform home safety assessments in a variety of settings
Desired Qualifications
- Gerontological Nursing Certification
- Experience with Medicare Annual Wellness Visits, care management, home-based primary care, and serving Medicare and Medicaid populations
- Experience working in assisted living, skilled nursing, or other senior living settings
- Familiarity with Athenahealth EHR
- Knowledge of Medicare quality initiatives, value-based care, ACO REACH, MSSP, APCM, and Chronic Care Management programs
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