The Complex Care Nurse ensures our High Risk Patient population (Primary care patients and Office Based Addiction Treatment (OBAT) program patients) are properly managed including, referrals, consults, tests, medication management, and patient education to ensure or move toward optimal wellness.
We are looking for a dedicated Nurse to join our Complex Care Team! Hours are Monday through Friday, no weekends. We offer a comprehensive benefits package with generous PTO and 11 additional paid holidays.
Job Duties :
- Ensures High Risk Patient population (Primary Care, OBAT, Complex Care) is properly managed including, referrals, consults, tests, medication management, and patient education to ensure or move toward wellness.
- Ensures High Risk Patients have a completed care plan and documents in the EMR.
- Acts as Health Educator for Complex Chronic Disease population (HIV, Hep C etc.)
- Completes at least 16-20 scheduled patients facing clinical hours per week of individual or group visits.
- In conjunction with team and / or provider, assists in the development and implementation of a comprehensive plan of care.
- Assists providers with on-going assessments and evaluates needs and interventions based on the current status adjusting the care plan as required assuring compliance and understanding of the long-term plan.
- Communicates with all staff, patients, and families demonstrating excellent written and verbal skills.
- Supports transitions of care through nurse visits after ED / Hospitalizations as appropriate.
- Actively participates in the manual and automated clinical tracking programs to ensure compliance with clinical outcome measures, prevention and follow-up care.
Required / Preferred Education, Experience and Skills :
- Current MA Registered Nurse (RN), BSN preferred.
- 2-5 years of experience working with OBAT / Addiction preferred.
- Experience in a ambulatory and / or community health setting and experience in medical case management in acute care preferred.
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