Nurse Care Manager- One Care Worcester
$75,000–$85,000 year
On-siteWorcester, Massachusetts, United States
Job Summary
Advocate for individuals served by ensuring their voices are heard, empowering them to make informed decisions, and promoting autonomy. Include all appropriate parties in the Integrated Care Team, build relationships with community partners, and maintain accurate documentation of interactions, progress, and referrals. Reduce utilization of higher levels of care by supporting transitions from inpatient settings back into the community. Review initial and annual MDS assessments, provide post-hospitalization follow-up, and conduct a minimum of one monthly face-to-face outreach visit. Evaluate medical history and diagnoses, create person-centered care plans, and educate individuals and families on health-related matters. Monitor outcomes, collaborate with providers to ensure continuity of care, and assist with the Critical Incident Reporting process. Provide training to the care team regarding health and medical issues facing individuals served.
Required Qualifications
- High School Diploma or GED
- Registered Nurse license
- 1-2 years' work experience in related behavioral health, human services, and/or medical field
- Valid driver's license and reliable, legally registered vehicle
- Knowledge of mental illness, the interface between mental health and medical conditions and systems, substance use, and care management
- Working knowledge of community resources and how to help individuals served access them
Desired Qualifications
- Demonstrates cultural and linguistic competence in working with individuals of varied cultural backgrounds and linguistic needs
- Knowledge of and ability to utilize motivational interviewing techniques to help individuals identify strengths, set goals, and develop hope for the future
- Demonstrates willingness and ability to work with challenging and diverse populations
- Professional demeanor in communicating with individuals served, colleagues, and other providers
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