Boston Health Care for the Homeless Program Registered Nurse Care Coordinator in Boston, Massachusetts
Since 1985, the mission of Boston Healthcare for the Homeless (BHCHP) has remained to provide or assure access to the highest quality health care for all persons experiencing homelessness in the greater Boston area. Our dedicated clinical and non-clinical staff work hard to bring the mission alive. OneCare is a state initiative to improve health outcomes for patients under 65 eligible for both Medicare and Medicaid, many of whom have complex medical and behavioral health needs.
We?re looking for an RN Care Coordinator to work on a small, supportive team providing care management services to OneCare patients. You?ll support linkages between enrolled patients, BHCHP medical teams, and other providers. You?ll be trained by the Commonwealth Care Alliance to perform Minimum Data Set (MDS) assessments to create care plans customized to meet the needs of individual patients, as well as update these plans annually or when the patient has had a significant change in status. You will conduct outreach to support their progress toward better health outcomes. As these patients may be living in shelters or on the streets, you?ll need to be resourceful to connect with them.
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
Communicates 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.
Qualifications and Competencies
Licensed as RN in Commonwealth of Massachusetts, with 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 under-served populations
Strong medical and surgical assessment skills
Understanding of substance abuse and mental health
Willingness to travel to outreach/various sites
Valid driver?s license and car required or strongly recommended to travel to multiple sites
Excellent organizational and interpersonal skills
Experience with documenting in EMR strongly preferred
Does this amazing opportunity interest you? Then we'd love to hear from you.
An Equal Opportunity Employer.