Assessment RN

Mass General Brigham•Somerville, MA

2d•$58,656 - $142,449•Hybrid

About The Position

Mass General Brigham Health Plan seeks an Assessment Registered Nurse (RN) to perform initial and ongoing comprehensive assessments and evaluations for members, conducted face-to-face, virtually, or by telephone. The RN ensures assessment accuracy and quality and submits documentation to MassHealth on time. Using tools such as the Minimum Data Set (MDS), Comprehensive, and Functional Assessments, the RN gathers relevant information to identify member concerns and unmet needs. The Assessment RN works closely with each member’s Interdisciplinary Care Team and other departments to coordinate timely interventions and improve outcomes. The population primarily includes members in Massachusetts counties, with the geographic focus and caseload subject to change based on enrollment trends. This is a full-time hybrid position combining practice-based work, remote work, and in-person visits to members’ homes and community or residential locations. The schedule is Monday through Friday, 8:30 AM–5:00 PM EDT. The role requires local presence, ideally in Eastern Massachusetts, and community travel. The RN has autonomy to build a schedule around member needs. Remote work requires a stable, quiet, secure, compliant workstation and access to Teams Video using Mass General Brigham equipment.

Requirements

Bachelor’s degree in Nursing required.
Massachusetts Registered Nurse (RN) license.
Valid driver’s license and reliable transportation.
At least 3–5 years of experience in health plan or community case management.
Experience working with individuals with complex medical, behavioral, and social needs.
Strong communication and interpersonal skills to engage enrollees and interdisciplinary teams.
Critical-thinking and problem-solving skills, with autonomy in decision-making.
Use prudent judgment based on objective information, clinical experience, and the nursing process.
Strong organizational skills and ability to manage routine work, triage, and reset priorities.
Ability to work effectively with providers and their staff to build rapport and trust and promote population health initiatives.
Excellent oral, written, and telephonic communication skills.
Competency working with multiple healthcare computer platforms.
Ability to work in a complex, fast-paced medical environment and across multiple practice locations.
Ability to work independently while contributing to a collaborative team.
Knowledge of healthcare and community services.
Ability to adapt to change and pivot as part of continuous process improvement.
Ability to accommodate the hybrid model, including practice-based work, remote work, and in-person home and community visits.
For remote work, ability to maintain a stable, quiet, secure, compliant workstation and access Teams Video using Mass General Brigham equipment.

Nice To Haves

Master’s degree in Nursing.
Experience with community case management and comprehensive assessment (MDS).
Experience with dual-eligible populations (Medicare and Medicaid).
Bilingual ability in English and Spanish, Portuguese, French, and/or Chinese.
EPIC experience.

Responsibilities

Conduct initial and ongoing comprehensive assessments and evaluations for members, using face-to-face visits, telephone, or electronic communication according to enrollee preferences and needs.
Travel to enrollees’ homes, community locations, and residential sites to complete assessments.
Independently manage scheduling, including coordinating face-to-face appointments with members.
Collaborate with primary care providers, the interdisciplinary team, and the community care management team to coordinate care.
Complete medication reconciliation.
Provide acute and chronic disease management education.
Analyze assessment data and share it with the Interdisciplinary Care Team to support development of an individualized care plan.
Ensure assessments are accurate, high-quality, and submitted to MassHealth on time.
Adapt to frequent, fast-paced changes and shifting priorities.