Complex Care Manager RN — Primary Care Impact

Boston Medical Center (BMC); Boston (MA); On-site; USD 90,000 - 130,000; Full time

Job summary

Boston Medical Center seeks a Complex Care Manager RN to work within the Pop Health team embedded in local primary care practices. The role partners with PCPs, Behavioral Health, pharmacists, and community resources to create multi-disciplinary care plans for high-risk patients.

The position is full-time (40 hours/week) with weekday hours, no weekends, and compensation tied to salary/incentive plan. RN licensure in MA and CCM certification are welcomed; two years of clinical care management

Qualifications

• Nursing degree required; BSN preferred with ability to obtain BSN within 4 years.
• CCM Certification preferred for the role.
• Licensed RN in Massachusetts and/or completion of an accredited NP program.

Responsibilities

• Identify and recruit appropriate patients for care management from lists and referrals, in collaboration with supervisors and local clinical site leaders.
• Comprehensive bio-psycho-social-spiritual assessment of patients.
• Collaborate with patient and care team to develop patient-centered care plan, focusing on chronic disease management, social determinants, transitions of care and advanced care planning (HCP, MOLST).
• Implement care plan and coordinate with community partners, such as VNA agencies, caregiver programs and social service agencies.
• Use motivational interviewing to promote behavioral change and engage patients in their care.
• Meet the patient where they are and observe without judgment.
• Triage clinical changes and respond rapidly to prevent emergency needs.
• Maintain HIPAA standards and documentation; participate in rounds and team meetings.
• Care Manager will work full-time at the clinical site of care.

Skills

Interpersonal skills

Collaboration

Motivational interviewing

Patient-centered care

Chronic disease management

Social determinants of health

Program planning

HIPAA privacy

Time management

Education

Nursing degree (Diploma/ASN/BSN)

BSN/MSN preferred

CCM Certification preferred

Massachusetts RN license or NP program

Job description

Boston Medical Center seeks a Complex Care Manager RN to work within the Pop Health team embedded in local primary care practices. The role partners with PCPs, Behavioral Health, pharmacists, and community resources to create multi-disciplinary care plans for high-risk patients.

The position is full-time (40 hours/week) with weekday hours, no weekends, and compensation tied to salary/incentive plan. RN licensure in MA and CCM certification are welcomed; two years of clinical care management