RN Case Manager North (2)

Vitra Health is a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs— supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care.

To help share our mission and expand our community impact, Vitra Health is seeking 3 Registered Nurse Case Managers who are passionate about community engagement and helping people access the care and resources they deserve.

As a Registered Nurse, in addition to executing assessment and admission visits, you will provide non-clinical support, educating clients and caregivers. Areas will include health maintenance and preventative measures, assisting in healthcare management navigation and accessing community support. If you are someone passionate about advocating for your clients and facilitating the success of clients remaining safely in their homes, we encourage you to apply today! Key Responsibilities

Complete intake and annual assessment and admission visits.

Complete all required documentation including client assessment forms and multidisciplinary plan of care and communicate professionally with client PCP and other healthcare providers when necessary.

Review all information in the client's admission binder, ensuring understanding as well as educating the caregiver on use of the MH required caregiver communication tool or electronic visit verification system depending on program participation.

Complete regular, in-home visits, caregiver education/skills training and assess health and environmental changes

Conduct semi-annual visits, reviewing and updating existing plan of care and corresponding goals, medication review and reconciliation and review caregiver communication tools.

Address concerns regarding environment, psychosocial status and changes in physical health.

Participate in multidisciplinary team meetings and work collaboratively to address client needs.

Perform other duties within the scope of practice as assigned by management.

Willingness to travel within assigned region required.

Valid driver’s license and reliable transportation required.

Licensed as an RN by Massachusetts Board of Registration in Nursing, required.

Minimum of two-year recent experience in the direct care of elders or adults with disabilities.

Fluency in both English and second language strongly preferred.

Case management, behavioral health, social services and/or community health worker experience preferred.

Strong communication, documentation and organizational skills required.

Must be solution oriented and able to multitask.