RN - Clinical Care Manager MAT Program

Are you looking for a meaningful career making a difference in our local communities? Are you passionate about health equity?

Do you enjoy helping people? Edward M. Kennedy Community Health Center is one of the largest community health centers in Massachusetts serving Worcester, Framingham, Milford and the surrounding communities.

We are a thriving and growing organization, and our team is expanding across sites to support this growth. We are currently hiring a RN Clinical Care Manager based in Worcester MA.

The Clinical Care Manager (CCM) provides, coordinates, and organizes evidence-based care management to our Medical Assistant Treatment Program (MAT) patients.

As an employer of choice, our inclusive workplace environment fosters teamwork, accountability and respect and supports the growth and development of each employee.

We are an equal opportunity employer and embrace the richness of the diversity of our staff and community. You are a good fit for our team if you’re passionate about helping people live healthier lives and enjoy working in a supportive, team-based environment.

Essential Functions Responsible for assisting Primary Care Providers (PCPs) in coordinating and managing the care of MAT program patients, ensuring that patients receive optimal care including acute illness and chronic disease management, education about lifestyle and behavior modification, and preventive care across multiple health settings with multiple providers Manages care plans for patients admitted to and discharged from the hospital, patients seen the emergency room, and patients transitioning from or to any other health care facility with the objective of preventing further disease exacerbation, improving outcomes, increasing patient engagement in self-care, decreasing risk status, and minimizing hospital and ER utilization.

Identifies, manages, and coordinates patient care and provides ongoing communication to the care team regarding patient care, patient needs, plans of care, and changes in status Provides direct patient care within the nursing scope of practice including, but not limited to, patient assessment, administration of vaccinations and medications, medication reconciliation, point-of-care testing, treatments, and lab and diagnostic test result review Provides timely and informed patient triage Involves the patient and their support systems in communication, care coordination, care planning, and education Assists patients in building a patient action plan which includes self-management goal setting and a disease exacerbation prevention plan.

Utilizes behavioral strategies to assist patients in adopting healthy behaviors, improving self-care and managing chronic disease with a focus on educating and optimizing the member’s level of independence in navigating the healthcare system at all levels of the continuum.

Maintains a registry of MAT patients with documented completion of measures and interventions Documents patient care, ongoing evaluation, patient progress / risk status, care manager interventions, and a plan of care developed with the PCP, in the EHR in accordance with health center and nursing standards.

Please note this position may require evening, weekend and / or holiday shifts on a rotating basis. Education and Experience Registered Nurse License in MA Bachelor’s degree in Nursing from an accredited college or university 1-2 years of clinical experience Current CPR certification Our health center requires all employees to have the most recent COVID-19 booster and the yearly flu vaccine.

Benefits : Competitive salary based on related experience Medical insurance starts on first day of employment. Health center pays 80% of medical insurance premiums.

Includes coverage for same-sex domestic partners and gender affirming care. Generous time off packages Dental and Vision insurance 403b Retirement Plan with employer match Flexible Spending Accounts Employee Assistance Program Powered by JazzHR