Substance Use Disorders Registered Nurse Case Manager
2 weeks ago
The Substance Use Disorders Registered Nurse Case Manager will act upon the order of Primary Care Providers to conduct intake assessments, patient monitoring, tracking, and ongoing support to patients with substance use disorders and chronic pain management issues. The successful candidate will ensure patients' adequate linkages with behavioral health counseling, other levels of substance use care, including medication-assisted treatment, and chronic pain management care.
Key Responsibilities
- Conduct intake assessments, including medical history, medication history, drug and alcohol history, lab work, and urine toxicology screen.
- Develop individualized treatment plans based on patient needs assessments, consents, and contracts.
- Make patient referrals to behavioral health and human services providers at the Health Center for needed services.
- Coordinate induction, stabilization, and maintenance of medication-assisted treatment when appropriate.
- Provide ongoing nursing visits, educate patients about medication treatment side effects, interactions, safety, administration, and plan of care.
- Document patients' progress in the electronic health records, adhering to state and federal regulations and requirements specific to medication-assisted treatment.
- Monitor and track patients, including progress in their treatment plan, and update Primary Care Providers and submit monthly reports.
- Provide consult support to staff as needed on new and current patients in treatment.
- Engage with health center staff as part of the team and provide support, education, and assistance to them in caring for patients with substance use disorders and chronic pain issues.
- Maintain ongoing communication with Primary Care Providers and staff with appropriate documentation and follow-up.
- Lead multi-disciplinary care coordination team meetings to discuss patients' progress and need for additional support and follow-up.
- Communicate with outside agencies with ongoing plan of care of patients and support as needed with appropriate consents.
- Follow-up with new, non-compliant, and lost to follow-up patients to ensure continuity of care.
- Participate as a member of the OD2A project and conduct the following:
- Engage and screen patients into substance use navigation services with a focus on the four OD2A project priority groups.
- Facilitate activities for UCC patients focused on overdose prevention, decreasing stigma, and increasing access to care.
- Disburse OD prevention supplies and Rescue kits for patients in medication-assisted treatment and primary care.
- Complete in a timely manner all data collection required by the OD2A project.
- Participate in OD2A project required trainings and meetings.
Requirements
- Licensed as a Registered Nurse in Massachusetts.
- Two years of nursing experience, preferably in an ambulatory care or community health setting.
- Experience with Substance Use Disorders and chronic pain management is a plus.
- Experience with case management and care coordination.
- Experience with EMR and related care management registries, databases, and Information Technology/Computer Systems.
- Demonstrated ability to work as an integrated member of a Multidisciplinary Care Team.
- Excellent communication and clinical judgment skills.
- Ability to follow and adhere to care model's operating procedures and standards.
- Experience in a culturally diverse setting.
- Bilingual language skills in English/Spanish, Portuguese, or Vietnamese preferred.
Supervisory Responsibility
None
Access Level to PHI
Level 4 [Authorized to access full health information]. This position and job responsibilities involve the provision of patient care and working as a clinical team member. Staff in this category level, although allowed full access, should only access the necessary information for each respective treatment and encounter/circumstance.
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