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Temporary Nurse Care Manager
2 months ago
Who We Are:
Since 1985, BHCHP’s mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community’s most vulnerable—and most resilient—citizens.
From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face.
Bilingual, Bicultural, LGBTQIA identifying,Black, Indigenous, and People of Color are encouraged to apply.
To learn more about working at BHCHP, watch our video Please Click Here.
Job Summary:
***NOW OFFERING A $4,000 SIGN ON BONUS***
Hours: Full-time, Monday through Friday 8:30am-5:00pm; part-time would be considered. Temporary role for 6 months.
The Behavioral Health Community Partners program is a MassHealth program that provides eligible enrollees with support to better manage their complex medical and mental illnesses and substance misuse. This program also primarily focused on individuals lacking stable housing. In this role, you will act as a highly autonomous driver of patient wellness by creating and enacting person-centered care plans for a set patient panel in direct partnership with 3-4 Care Coordinators and the patients themselves. This is an outreach position, enabling you to truly meet the patient where they are at, and requires a population health lens to provide both preventative and reactionary services.
As a Nurse Care Manager, you will use clinical expertise to collaborate with the broader interdisciplinary care team (Primary Care Providers, BH clinicians, etc.) to ensure that the enrollees are receiving needed services, have adequate access to necessary knowledge and resources, and are measuring progress towards the goals outlined in their patient-centered care plan.
This is an excellent position for those wanting to address social determinants of health and systemic inequities at both micro and macro levels in conjunction with key stakeholders throughout the city. Initially, this position will cover a current staff member’s leave with the possibility of transitioning to other nursing positions at BHCHP at the end of the 5-month employment span.
Responsibilities:
- Enact essential duties through a mix of 3 onsite and 2 remote days a week.
- Provide clinical assistance to 3-4 Care Coordinators with panels of approximately 45 patients each. This includes chronic disease management and medication support.
- Engage vulnerable populations as part of a multidisciplinary outreach team. This includes home visits, outreach to hospitals, homeless shelters and other settings, as needed.
- Perform timely follow up and medication support following transitions of care.
- Connect enrollees to various needed supportive services and resources.
- Provide clinical oversight and tracking for annual comprehensive health assessments.
- Participate in developing patient-centered care plans and reviewing health assessments for the BH CP enrollees on their panel.
- Work with BHCHP staff at Boston-area hospitals to coordinate hospital admission/discharge plans with the behavioral health clinician, PCP, ACO, MCO etc.
- Use data to evaluate outcomes of targeted interventions for panel. Assist in developing appropriate adjustments to care plans based on this data.
- Implement prevention & engagement strategies in collusion with Care Coordinator.
- Provide health coaching for groups of enrollees or individual enrollees as needed.
- Support connection to substance use treatment and affiliated services when appropriate.
- Engage in quality improvement efforts, as led by the BH CP Clinical Team Coordinator and Clinical Program Manager.
Qualifications:
- Licensed as RN in Commonwealth of Massachusetts. BSN preferred but not required.
- 3-5 years nursing experience with complex patients preferred
- Experience working with vulnerable populations, including persons with a history of trauma, those experiencing socioeconomic stress, homelessness, or substance use disorders
- Strong interpersonal skills and clinical problem solving
- Comfort working in an autonomous clinical setting and nursing in an outreach setting
- Capability working with data to track and measure performance
- Bilingual skills in Spanish and English preferred
- Computer skills: Proficient with Microsoft Excel Spreadsheets, entering narrative and other data into a database, Epic EHR
- Flexibility and strong multitasking skills
