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RN Care Coordinator - Hybrid (remote/in person)

Company: Boston Health Care for the Homeless Program
Location: Boston
Posted on: May 28, 2023

Job Description:

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 12,000 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 60 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 .Job Summary:***NOW OFFERING A $4,000 SIGN ON BONUS***Hours: Full-time; Monday- Friday 8:30am-5:00pm, (Hybrid, in person work is expected in combination with remote work)BHCHP is seeking a Registered Nurse who is interested in flexible weekday hours and working on a small, tight-knit team that provides care management services to patients enrolled in the OneCare Program. The OneCare program is a state initiative to promote care coordination, continuity of care, and improved health outcomes for those patients under 65 who are eligible for both Medicare and Medicaid. As the OneCare RN, you will collaborate with OneCare team members to support linkages between enrolled patients and BHCHP medical teams and other providers. You will be required to undergo training from the Commonwealth Care Alliance to perform Minimum Data Set (MDS) assessments and create care plans customized to meet the needs of individual patients. You will also help update these plans annually and when a patient has had a significant change in status. In this role, you will go out on outreach to meet with patients, assess their status, and support the patient's progress toward better health outcomes. The RN will also connect with patients by phone, communicate with providers about patient needs, and connect patients to needed services including visiting nursing, nutrition, and social services. Patients may be housed; living in shelters or on the streets and you will need to be resourceful to connect with our patients. It is anticipated that success with connecting with patients will require communication with BHCHP care teams and shelter partners, use of BHCHP and CCA electronic medical records, as well as outreach to patients who are living on the street, shelter, or in temporary or permanent housing. Responsibilities:

  • Assumes responsibility for the coordination of care between BHCHP medical teams and the OneCare program for BHCHP patients who are enrolled in the OneCare Program.
  • Conducts MDS assessments for patients enrolled in the OneCare program.
  • Collaboratively participate and communicates clearly and professionally as a member of the primary care team that includes M.D.s, N.P./P.A.s, Clinical RNs, Behavioral Health Clinicians, Medical Assistants, Case Managers and others.
  • Communicates clearly and professionally with patients and/or caregivers including performing outreach as necessary in the greater Boston area for face-to- face contact to homes, hospitals, other facilities, etc. as needed to assess build relationships, patient status, and identify new care needs.
  • Uses OneCare's and BHCHP's Electronic Medical Records (EMR) in a timely manner to note all patient interactions and outcomes accurately and efficiently; bills for MDS assessments into EPIC weekly.
  • Conforms to BHCHP standards of performance around patient rights, customer service, infection control, safety procedures and culturally competent care.Qualifications:
    • Licensed as RN in Commonwealth of Massachusetts; 1- 2 years RN experience preferred.
    • Previous community health center or primary care experience.
    • Demonstrated interest in public health, primary and preventive nursing and working with an under-served population; interest in working with disadvantaged groups.
    • Strong medical and surgical assessment skills; understanding of substance abuse and mental health.Excellent organizational and interpersonal skills; experience with documenting in EMR strongly preferred.
    • Ability to work as part of a team and autonomously; timely and strong communication skills via phone, e-mail, and internal secured messaging systems.
    • Ability to prioritize and have attention to timetables to complete task.
    • Experience with documenting in EMRs: EPIC, Guiding Care, and ECW strongly preferred.
    • Must be able to work with and cooperate with multidisciplinary teams to achieve best patient care.
    • Proficient with Microsoft Office Suite and ability to adapt to technological changes; must be well organized, efficient and can work autonomously and within a team.
    • Willingness to travel to outreach/various sites; driver's license a plus.Compensation and Benefits:
      • The compensation starts at $35.22 per hour and increases based on years of experience.
      • BHCHP full time employees are eligible for our competitive time off policy of 4 weeks' vacation, health, dental and vision insurance, 403B retirement savings plan and employer retirement contribution, and pre-tax MBTA pass program with 40% discount. In addition, eligible employees will receive yearly increases, additional compensation of seven thousand five hundred dollars added to your base hiring rate for demonstrated bilingual proficiency and the opportunity to work with local hospitals and community health centers.Does this amazing opportunity interest you? Then we'd love to hear from you.
        As an Equal Opportunity Employer, BHCHP pledges not to discriminate against and encourages those from underrepresented and underserved backgrounds to apply, particularly Black, Indigenous, and People of Color (BIPOC), LGBTQIA identifying, first generation college students and adults without a college degree, Bilingual and Bicultural persons; and individuals from low economic backgrounds.
        Covid-19 Vaccination: For the protection of our workplace and patients, BHCHP requires all staff to be fully vaccinated against Covid-19. Proof of Covid-19 vaccination(s) is required for employment. All candidates offered employment will be given details about how to demonstrate receipt of vaccination.
        Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.

Keywords: Boston Health Care for the Homeless Program, Boston , RN Care Coordinator - Hybrid (remote/in person), Healthcare , Boston, Massachusetts

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