Nurse Care Manager- One Care Worcester

Behavioral Health Network (BHN) is a leading statewide provider of behavioral health services and a Certified Great Place to Work. Since 1938, BHN has helped individuals, families, and communities thrive through compassionate, high-quality care and support.

About the role

We are currently seeking a Nurse Care Manager to join our One Care team and help advance our mission of empowering people to live healthier, more fulfilling lives.

Responsibilities

• Act as a strong advocate for individuals served, ensuring their voices are heard and their needs are met, and empower them to make informed decisions about their care while promoting autonomy and self-determination.
• Include all appropriate parties in the individual's Integrated Care Team, including primary care providers, behavioral health providers, and others as indicated by the individual served.
• Build and maintain strong relationships with community partners, including social service agencies, healthcare and behavioral health providers, and other relevant organizations.
• Complete and maintain accurate and timely documentation of individual served interactions, progress, and referrals, and complete necessary reports for funding agencies and other stakeholders.
• Work to reduce individuals served utilization of higher levels of care when appropriate and support transitions from inpatient settings (e.g., emergency room, inpatient hospitalization, detox) back into the community.
• Review initial and annual MDS assessments in collaboration with the care team to identify health needs, safety concerns, and gaps in care.
• Provide care management services including post-hospitalization follow-up and medication reconciliation.
• Provide ongoing care management for an assigned caseload, collaborating with the care team to identify risks or gaps in individuals' physical or mental health care.
• Promote the use of InstED emergency department services with individuals served and the care team.
• Perform a minimum of one monthly face-to-face outreach visit from the assigned caseload, understanding frequency may change according to individual and program needs.
• Evaluate individuals served medical history and diagnoses for accuracy; assess health needs, health history, and existing support network.
• Assist the care team in creating a person-centered care plan and scheduling appointments as needed.
• Educate individuals served and their families/supports on relevant health-related matters.
• Monitor individuals served outcomes and collaborate with medical and/or behavioral health providers to ensure continuity of care, providing recommendations for treatment changes as appropriate.
• Maintain familiarity with One Care policies and procedures and adhere to updates or changes.
• Provide ongoing information, periodic reviews, and documentation to support care plan goals and objectives.
• Work with individuals served, providers, and care team to help close gaps in care and advocate for best health and wellness outcomes.
• Consult with community agencies, providers, and informal supports to maintain coordination in the treatment process.
• Consult with the care team on cases as needed regarding medical and/or behavioral health issues.
• Provide consultation and assist with completion of the Critical Incident Reporting process as needed.
• Provide formal and informal training to the care team regarding health/medical issues facing individuals served.

Requirements

• High School Diploma or GED required.
• Registered Nurse license required.
• 1-2 years' work experience in related behavioral health, human services, and/or medical field required.
• Demonstrates cultural and linguistic competence in working with individuals of varied cultural backgrounds and linguistic needs.
• Knowledge of and ability to utilize motivational interviewing techniques to help individuals identify strengths, set goals, and develop hope for the future.
• Demonstrates willingness and ability to work with challenging and diverse populations.
• Working knowledge of community resources and how to help individuals served access them.
• Knowledge of mental illness, the interface between mental health and medical conditions and systems, substance use, and care management.
• Professional demeanor in communicating with individuals served, colleagues, and other providers.
• Valid driver's license and reliable, legally registered vehicle available for all working hours required.

Benefits

• Purpose-Driven Work – Make a meaningful impact in the lives of individuals, families, and communities throughout Western Massachusetts.
• Professional Growth – Access ongoing training, mentorship, career development, and advancement opportunities across one of the region's largest behavioral health organizations.
• Supportive Team Culture – Join a collaborative workplace guided by our HEART values: Humanity, Empowerment, Accountability, Respect, and Teamwork.
• Stability & Opportunity – Build your career with a well-established organization serving Western Massachusetts since 1938.
• Comprehensive Benefits – Generous PTO, 403(b), educational assistance, medical, dental, vision, employee assistance programs, and more.
• Certified Great Place to Work – Work for an organization recognized for creating a positive and engaging employee experience.

Pay

Salary Ranges: $75,000-$85,000