Behavioral Health TOC RN – Hybrid Care Coordinator

Lawrence Partnership; Massachusetts; Hybrid; USD 10,222,000 - 12,000,000; Full time

Benefits offered by this job

Tuition reimbursement

Comprehensive benefits package

Growth opportunities

Great working environment

Job summary

Greater Lawrence Family Health Center (GLFHC) seeks a Registered Nurse, Behavioral Health TOC Coordinator to help high‑risk patients transition from inpatient, ED and other settings back to the community. The role emphasizes behavioral health needs, care continuity and reducing avoidable costs, interfacing with hospitals and integrated care teams.

This hybrid position offers remote opportunities with onsite meetings, focusing on timely follow-up and coordinated discharge planning for complex

Qualifications

• Bachelor’s degree in Nursing and MA RN licensure required.
• 2–3+ years of behavioral health, care coordination, case management or transitions of care experience.
• Bi-lingual Spanish speakers are highly desirable.

Responsibilities

• Identify and track patients discharged from inpatient facilities and ED.
• Conduct outreach within 24–72 hours post-discharge to align with TOC requirements.
• Ensure 7-day post-discharge follow-up after behavioral health events.
• Monitor missed or canceled appointments to maintain continuity of care.
• Develop, implement and update individualized care plans with care teams.
• Coordinate services with C3 ACO BH TOC team across service areas.
• Work with primary care, behavioral health providers, hospitals and community orgs.
• Address barriers to care (transportation, housing, social needs).
• Support referral completion and follow-up services.

Skills

Care coordination

Multidisciplinary teamwork

Flexible approach

Effective communication

Education

Bachelor’s degree in Nursing

RN license in MA

Job description

Greater Lawrence Family Health Center (GLFHC) seeks a Registered Nurse, Behavioral Health TOC Coordinator to help high‑risk patients transition from inpatient, ED and other settings back to the community. The role emphasizes behavioral health needs, care continuity and reducing avoidable costs, interfacing with hospitals and integrated care teams.

This hybrid position offers remote opportunities with onsite meetings, focusing on timely follow-up and coordinated discharge planning for complex