Coordinate and manage care for complex patients with the care team.
Support disease management and patient education.
Conduct comprehensive patient assessments.
Track referrals and coordinate care across settings.
Engage patients and families in care planning.
Connect patients with community resources for support.
Monitor and document patient progress.
Benefits
Medical insurance starts on the first day of employment, with 80% of premiums covered.
Generous time off packages.
Dental and Vision insurance provided.
403b Retirement Plan with employer match.
Flexible Spending Accounts available.
Employee Assistance Program offered.
Full Job Description
Salary Range: $40.00-45.00/Hour Final Salary determined on experience, licensure, etc.
We are currently hiring a Nurse Manager- Clinical Care based in Worcester, MA. The CCM Nurse Manager provides clinical leadership for the Community Health Center's Complex Care Management programs. This role oversees team-based care, care coordination, quality improvement, and staff management while collaborating with providers and care team members to improve patient outcomes.
Essential Functions
Coordinate and manage care for complex patients in collaboration with the PCP and care team.
Support acute and chronic disease management, preventive care, patient education, and healthy lifestyle goals.
Conduct comprehensive assessments and communicate patient needs, care plans, and changes in status.
Track referrals and coordinate care across providers and healthcare settings.
Engage patients and families in care planning, decision-making, and self-management goals.
Connect patients with Health Center and community resources to support independence and access to care.
Monitor, evaluate, and document patient progress and risk status.
Collaborate with multidisciplinary teams to ensure high-quality, coordinated patient care.
Review assigned patient lists and coordinate complex cases with appropriate ACO, Behavioral Health, and Medical care managers.
Follow the C3 short-term Complex Care Management model and monitor key performance indicators.
Facilitate group-based medical visits to promote patient education, community building, and peer support.
Education and Experience
Registered Nurse License in MA
1-2 years of clinical experience
Current CPR certification
Benefits:
Competitive salary based on related experience
Medical insurance starts on the first day of employment.
Health center pays 80% of medical insurance premiums.
Includes coverage for all individuals and most family types.
