Registered Nurse - Health Home, Fee-For-Service (RN, FFS)

Eliot Community Human Services provides a wide range of community based services for individuals and families of all ages in the areas of mental health, developmental disabilities, early intervention, counseling, substance abuse and youth programming.

We are seeking a dedicated and compassionate Nurse to join our team, committed to delivering exceptional care and support.

This role involves working closely with the Health Home team to ensure the effective coordination of personalized care plans and providing essential education and resources to our members.

Responsibilities :

• Provide insight and guidance regarding Member's Person-Centered Care Plan (PCCP)
• Coordinate authorizations and service referrals with Commonwealth Care Alliance (CCA) Utilization Management and Clinical Operations Team and participate in care transitions and post discharge follow-up where indicated
• Document care coordination activities and data such as member and provider engagement, assessments, care plans, service referrals, care transitions work, and member demographic information, in CCA's electronic platforms
• Provide education, consultation, and care coordination to active enrollees on the Health Home team
• Assist enrollees with accessing community resources that will support and assist with addressing needs and health wellness efforts
• Provide oversight, guidance, and assistance to enrollees with understanding their medical conditions
• Meet with enrollees and Health Home team members to discuss any medical diagnoses and conditions, causes, symptoms, complications, and treatment options
• Provide medication reconciliation following Eliot / CCA procedures related to enrollees on Health Home team assignment
• Review all medical documentation for each enrollee as assigned on corresponding Health Home team and provide medical care consultation and coordination as needed
• Assist the Care Team, Health Home team, and enrollees by providing methods for ongoing assessment of symptoms and treatment effectiveness and identifying appropriate responses / actions
• Act as liaison to medical providers for enrollees and assist enrollees in engagement with medical providers, recommendations, and other types of health / medical supports
• Develop working relationships with community medical providers, PCPs, and other community-based services in order to assist with coordinating medical care for enrollees on the team.

Assist with acting as a liaison to communicate medical issues and concerns to medical providers and ensuring the treatment team understands these concerns

Qualifications :

• Licensed registered nurse with at least two years of experience working with people with severe and persistent mental illnesses or providing medical coordination establishing supportive relationships and respect for treatment preferences
• Valid driver's license and reliable transportation
• Demonstrates sound judgment and effective, solution-focused problem-solving skills
• Ability to develop and maintain professional working relationships with consumers, staff, co-workers, and supervisor
• Ability to work effectively with diverse populations and cultural groups
30+ days ago