Job Information
East Boston Neighborhood Health Center RN Care Manager in East Boston, Massachusetts
Thank you for your interest in careers at EBNHC!
Everywhere you turn, you can feel it. There's an immeasurable level of enthusiasm at East Boston Neighborhood Health Center (EBNHC), one of the largest community health centers in the country. From the nurses and physicians on the front line of patient care, to the managers who shape our policies, to the customer service representatives who keep our facilities running smoothly - everyone here has a role in making medicine better.
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Time Type:
Full time
Department:
Pediatrics
All Locations:
East Boston
Description:
EBNHC is a member of Well Sense, a 501(c)(3) not-for-profit, Accountable Care Organization (ACO) governed by FQHCs. Our mission is to leverage the collective strengths of Federally Qualified Health Centers (FQHC) to improve the health and wellness of the people we serve.
As an integral member of the care management team the Registered Nurse (RN) Care Manager (CM) will have the opportunity to make a profound impact on the lives of people living with complex and/ or chronic conditions, many of whom also face multiple barriers in their lives which makes it difficult for them to achieve the self-care required to improve their health and well-being. This position requires flexibility and may vary from day-to-day to meet members where they are. Outreach methods may vary based on the needs of the organization and may include telephonic or in person in a variety of potential settings such as but not limited to, the health center, community, home or an inpatient facility.
Essential Duties & Responsibilities
Conducts Comprehensive Assessments
Assures that medication reconciliation is complete.
Engages members and care givers in active care planning with focus on medical, behavioral, social, member-centered care needs. Coaches and guides member/representative to meet bio/psycho/social goals.
Provide care coordination, which may include but not limited to facilitating care transitions, supporting the completion of referrals, and/or providing or confirming appropriate follow-up
Assesses the member’s knowledge of their medical, behavioral health and/or social conditions and provides education and self-management support including symptom response plans based on the member’s needs and preferences.
Connects members with primary care, behavioral health, flexible services, Community Partner, respite, and other community based social services as indicated and appropriate
In collaboration with Community Health Workers, creates and maintains a comprehensive inventory of local community resources through a web-based application, improving accessibility for members and providers, and linking members with the appropriate support services.
Participates in the integrated care team meetings and rounds as required
Maintain accurate, timely documentation in electronic systems including health center EHRs.
Provides coverage for team members who are out of office
Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual enrollees and the population served.
Be fully accountable for the completion of work within established timeframes and for achieving the goals established for the enrollee/family.
Ensure that all care management is offered in a culturally and linguistically appropriate manner and with disability competence.
Ensure that all needed accommodations are consistently made for members with disabilities.
Maximize the use of ACO care management tools and technology to ensure that work is comprehensive, detailed, automated and streamlined to the extent possible. Make recommendations to change workflows to enhance the ease of use, practicality and effectiveness of the ACO tools and processes.
Use information about data trends for self-directed learning and performance improvement.
Maintain excellent punctuality and attendance.
Promote a sense of “team work” through demonstration of self-direction and self-motivation. Solve problems independently or knows when to seek consultation.
Adheres to all EBNHC and departmental polices and procedures.
Participate in required departmental activities and meetings.
Perform other related duties.
EDUCATION:
Bachelor’s Degree in Nursing required.
Valid MA RN license required.
EXPERIENCE:
2-10 years of nursing experience, preferably with some combination of home health, ambulatory care, community public health and case management work experience. Including, the , coordination of enrollee care across multiple settings and with multiple providers.
Experience working with a Medicaid population is strongly preferred.
Experience working with Federally Qualified Health Centers is strongly preferred.
Case Management Certification (CCM, ANCC RN-BC) preferred.
SKILLS/ABILITIES:
Exceptional communication skills, both written and oral, ability to positively influence others with respect and compassion.
Reliable transportation with ability to travel offsite.
Fluency in a non-English language preferred.
Strong work ethic built on a foundation of proactivity and teamwork.
Ability to navigate ambiguity with the aid of structured problem-solving techniques.
Committed to the practice of inquiry and listening.
Experience working with patients with chronic and behavioral health needs.
Must be flexible and adaptable to change.
Demonstrate the ability to work independently.
Additional qualities that would be a good fit for our team include:
Enthusiasm and passion for helping patients, genuine spirit, kind, and empathetic nature, and one who embraces a ‘go with the flow’ mentality.
May need to work evenings/ occasional weekends to provide enrollee access and/ or follow up.
Demonstrated success in working as part of a multi-disciplinary team including communicating and working with Providers, Social Workers, Community Health Workers and other health care teams.
Experience using appropriate technology, such as computers, for work-based communication.
Experience and proficiency with Microsoft Office and online record keeping.
There’s a reason East Boston Neighborhood Health Center is ranked as one of the “Top Places to Work” by The Boston Globe. It is because we are committed to maintaining a truly supportive and welcoming environment — for both our employees and our patients — that reflects our mission and culture. A huge focus of which is to offer important benefits so you can be your best inside and outside of work.
Striving to be an employer of choice, we offer progressive benefits, a variety of schedules, and the satisfaction of working with a diverse workforce whose unity of purpose is a real force for achievement. Plus, our Education & Training Institute is an attractive resource for many of our employees who seek to broaden their skill base and advance their careers.
Medical & Dental Coverage
Life and Disability Insurance
Privileges at Boston Medical Center for Providers
401(K) Retirement Plan
Educational Assistance
Flexible Spending & Transportation Accounts
Paid Holidays, Vacations, Sick and Personal Time
A Generous Staff Development Benefit
Excellent Malpractice Coverage
A Designated Medical Staff Office for Physician Support
Free Parking
And Much More…