Fallon Health

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Nurse Practitioner Summit Eldercare (PACE Program)

Nurse Practitioner Summit Eldercare (PACE Program)

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About Fallon Health:


Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.



About Summit ElderCare:


Fallon Health operates one of the largest Programs of All-Inclusive Care for the Elderly (PACE)  in the country. Called Summit ElderCare, Fallon’s PACE program helps older adults and their caregivers to avoid or delay nursing home care. Participants in Summit ElderCare are cared for by a team of professionals and have access to social support and a wide array of  medical services in one convenient location while they keep the independence of living in their own homes and communities. 



Position Overview:


Provides primary health care to Summit ElderCare program participants focusing on disease prevention and/or stabilization, and management of chronic and episodic illness in collaboration with the program’s primary care physician providers. Works with the interdisciplinary team to establish realistic and measurable goals and to develop and manage individualized plans of care for program participants.


  • Performs initial and periodic comprehensive assessments of participants for the purpose of developing complete lists of medical diagnoses and plans of care, in collaboration with SE physicians
  • Evaluates participants with new symptoms or episodic illnesses and orders appropriate treatments and  interventions
  • Performs routine monitoring of chronic illnesses
  • Performs those interventions identified in the Interdisciplinary care plan as appropriate for the PCP and/or NP or PA
  • Participants in Interdisciplinary team meetings
  • Visits and provides assessments and care for SE participants in their homes, in Skilled Nursing Facilities, and in the SE Centers. Visits participants in acute care settings as appropriate to help with treatment decisions and discharge planning
  • Documents all care and services in succinct and accurate ways consistent with professional standards
  • Establishes and maintains effective working relationships with program participants, family caregivers, medical staff, and program staff
  • Provides after hours coverage for SE participants as assigned on Weekdays and Holidays
  • Participates in provider Chart reviews as requested by the medical director or associate medical director

    Recognizes, identifies, and implements opportunities to help meet Utilization goals 

  • Supports the fundamental mission of the Summit ElderCare program

  • Participates in quality assessment and performance improvement projects and workgroups


Education:  graduate of an accredited Nurse Practitioner program/Physician Assistant program. Maintain (and further develop when appropriate) competency in clinical practice through self study and attendance at educational programs.


License/Certification: Licensed by the Commonwealth of Massachusetts NP or PA

 National Board Certification as a Geriatric, Adult, or Family Nurse Practitioner


Experience: Three or more years of Nurse Practitioner or Physician Assistant experience in both an office setting and a long term care setting preferred,  Previous experience with an interdisciplinary
approach to care management. Facile with Electronic Health Records.