RN South Boston- Case Manager, Community Based

Vitra Health • Boston, MA

449d

About The Position

The in-home RN position at Vitra Health involves providing comprehensive support to clients in the Boston area, focusing on maintaining their health and safety in the community. The role emphasizes collaboration with caregivers and care managers to ensure compliance with program regulations and to prevent unnecessary hospitalizations. The RN will conduct assessments, provide training, and monitor clients' health status while working within an interdisciplinary team to implement client-centered care plans.

Requirements

• Licensed by the Massachusetts Board of Registration in Nursing.
• At least two years of recent experience in direct care of elders or adults with disabilities.
• Excellent interpersonal and communication skills.
• Valid driver's license with proof of insurance.
• Bilingual in English and Spanish strongly preferred.
• Relevant experience in healthcare, home health care, case management, or sales preferred.
• Previous experience with mental health aspects of care.
• Strong communication, writing, organizational, and time management skills.
• Solution-oriented with the ability to multitask.
• Proficiency with the Microsoft Office Suite.

Nice To Haves

• Experience in case management or sales in a healthcare setting.
• Bilingual skills in additional languages.

Responsibilities

• Conduct regular in-person visits with clients and caregivers to ensure safety and health in the community.
• Collaborate with the Care Manager to review and upload Care Communication Tools during visits.
• Evaluate potential clients and complete all components of assessment forms.
• Conduct orientation and ongoing training for new caregivers on health and aging topics.
• Complete nursing progress notes for each encounter or as needed based on the member's condition.
• Select, train, evaluate, and supervise AFC/FGAFC caregivers in conjunction with the care manager.
• Ongoing evaluation of clients' health status and program eligibility, including formal assessments.
• Complete required documentation such as Health Status Forms and Multidisciplinary Care Plans.
• Monitor clients' health status and complete semi-annual and annual health reports.
• Work collaboratively with the interdisciplinary team to create and implement client-centered Plans of Care (POC).
• Plan for and implement safe discharges and transitions to and from Vitra programs.
• Report observations and changes in clients' health status to their PCP.
• Follow all AFC and FGAFC policies and procedures when delivering care.

Benefits

• Supportive work environment focused on team health and happiness.
• Opportunities for professional development and training.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed