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Nurse Case Manager
4 months ago
About Us
We're more than just quality treatment for substance use disorders. We're a total health community. At SSTAR, our mission is healing the community, one person at a time. We will provide a personal level of healthcare and addiction treatment that addresses the mental, physical, and spiritual well-being of everyone we touch. SSTAR is a Federally Qualified Health Center (FQHC) which affords our employees eligibility to apply for one of our three Loan Repayment Programs.
The Nurse Case Manager is responsible and accountable for assessing, triage and developing a plan of care for patients whom, walk in, call in or are referred to the MAT Program at SSTAR. The Nurse Case Manager is responsible for working in collaboration with the MAT Team to assist patients with enrollment into MAT Services, primary care, inpatient, behavioral health, recovery coach services etc.
Benefits
- 403B
- Dental insurance
- Disability insurance through Massachusetts PFML
- Employee discounts, cell phone, eyewear etc.
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Flexible Spending Account
- Opportunities to earn CEU's
- Voluntary Benefits including but not limited to, Disability, Life, Critical Illness, Accident and Disability Insurances
Duties & Responsibilities
- Conduct initial assessment and intake obtaining social, medical, mental health, substance abuse and medication history
- Review Policy and procedures for Injectable medications update as needed
- Assign appropriate tasks to staff consistent with their job duties
- Coordinate with managed care case manager and LPN delivery of medications/stop delivery of medication
- Monitor medications that are on site for duplicate deliveries or delivers for patients that have been lost to care
- Attend Next Gen Round Up meetings report any issues r/t Next Gen usage/performance/problems
- Report Next Gen Round Up solutions/trainings/updates
- Facilitate meetings/staff trainings related to Next Gen upgrades/updates/workflow
- Provides direct patient care to patients with opioid and substance use disorders, screening, and telephone triage, performing intakes, supervising initial buprenorphine induction, and providing counseling on therapies for substance use disorder
- Responsible for improving the care of our patient population across health, substance use and mental health treatment, promoting patient activation and empowerment for shared decision-making in treatment, and encouraging healthy behaviors, self-management of health, mental health and substance use conditions
- Monitor the health status, treatment progress, and medication adherence of the OBAT patient panel
- Schedule follow up appointments/ Intakes/Inductions with nurse case managers /schedule intakes /follow ups with MAT provider /schedule follow up appointments /physicals with primary care providers
- Revise the patient plan of care with the OBAT treatment team, as needed, to address patient needs and issues
- Directly support our medical specialty providers and behavioral health specialists during clinical sessions
- Communicates and collaborates with care team providers including PCP, specialists, behavioral health providers, psychiatric nurse practitioner, caseworker and other team members as deemed appropriate
- Full Time Nurse Case Manager to carry a case load of 100-125 patients Provide follow up care in person and via telephone when needed
- Nurse Case Managers work Autonomously, following the Nurse Driven Model for all OBAT sites across Massachusetts.
- Review consents and treatment contracts with patients, obtaining signatures and giving the patient a copy and leaving a hard copy in the patient paper chart
- Facilitates and track referrals and serves as the central contact for patients and their families, BH providers, specialists when needed. Collaborate as needed with physicians, social worker, and specialty care physicians to whom the patient has been referred.
- Manage patients receiving opioid treatment medications on an ongoing basis
- Assessment of signs and symptoms of opioid withdrawal using the Clinical Opioid Withdrawal scale/CIWA Scale
- Monitoring of patients in the induction, stabilization, and maintenance phases of treatment
- Assess patients looking to access both behavioral health, and OBAT services at SSTAR Family Health Center
- Follow State and Federal guidelines in providing care to opioid-dependent patients
- Complete appropriate documentation with excellent record keeping including visit notes. Use clear concise and effective communication written/oral and comply with departmental policies when sharing/documenting relevant patient care data
- Collect pertinent data using appropriate assessment techniques i.e., OBAT intake and enrollment paperwork as well as quarterly OBAT questioner and OBAT Dis-enrollment paperwork. Submit to support staff for data to be entered into virtual gateway.
- Evaluate data according to the patient's immediate conditions and needs, review hospital records with MAT provider and/or PCP.
- Involve the patient, and appropriate health care providers in the collection of data when appropriate
- Ongoing education and support of patients in all phases of substance use treatment including nursing visits scheduled and unscheduled (walk -in), urine toxicology screens, routine labs and as needed, medication teaching, monitoring, medication counts, observed dosing, and medication refills
- Works with the specialty as well as retail pharmacies and the OBAT team in obtaining medication orders, prior authorizations, prescriptions, refills, and communication as needed
- Contact with outside agencies DCYF, Probation, Parole, Medical Providers.
- Obtain access to the Massachusetts Prescription Monitoring Program online portal look-up/review patient data document findings, alert provider if review has abnormal findings
- Collaborate and coordinate care with BH team members around psychiatric emergencies or crisis-related clinical concerns
- Attend weekly OBAT Team meetings
- Commit to a focus on continuous improvement of workflow processes and procedures
- Assume other responsibilities, as directed
- Must cooperate fully with SSTAR's Corporate Compliance Program and performs all tasks as assigned by the Director and/or CEO
Education & Experience
- RN/LPN License to practice in Massachusetts
- Knowledge of Medication for addiction treatment
- Current CPR Certification
- Experience caring for patient with mental illness or SUD required
- Ability to diffuse tense situations related to patient care
- Leadership experience with the ability to work autonomously
- Knowledge of community, and health resources, particularly substance use-related resources and supports
- Ability to interact and communicate with a variety of people, both on a one-on-one basis and in meetings and group presentations; must be able to relate to and work with ill, emotionally upset, and sometimes hostile people
- Ability to anticipate and react calmly to emergency situations
- Values cultural diversity and other individual differences in the workforce, ensuring that the organization builds on these differences
- CARN CERTIFICATION (once eligible after 2000 hours of clinic)
