RN Case Manager (Contract)

Key Responsibilities

• Complete in-person intake, admission, annual, and reassessment visits in accordance with program requirements.
• Conduct nursing assessments and evaluate clients' physical, psychosocial, and environmental needs.
• Collaborate with interdisciplinary team members to develop, implement, review, and update individualized plans of care.
• Assist with medication reviews and care plan updates as appropriate.
• Serve as a key member of the interdisciplinary care team, helping clients access healthcare services, navigate community resources, and maintain safe, independent living whenever possible.
• Provide education to clients and caregivers regarding health maintenance, disease prevention, medication management, and available community resources.
• Review admission materials and ensure clients and caregivers understand program requirements and expectations.
• Provide caregiver education and skills training to support quality care delivery.
• Assist clients and families with accessing healthcare services, community programs, and support resources.
• Conduct regular in-home visits to monitor client health, caregiver performance, psychosocial well-being, and environmental safety.
• Assess and address concerns related to changes in physical health, psychosocial status, or living conditions.
• Review caregiver communication tools and documentation requirements.
• Communicate professionally with clients, caregivers, primary care providers, and other healthcare professionals as needed.
• Participate in multidisciplinary team meetings and collaborate to address client needs.
• Complete all required documentation at point of service accurately and timely in accordance with organizational policies and state regulations.
• Maintain accurate detailed records of assessments, care plans, visits, interventions, and client outcomes.
• Ensure compliance with all applicable regulatory, clinical, and program requirements.
• Foster a culture of customer service and commitment to quality care.
• Serve as a brand ambassador for Vitra reflecting our vision, mission, and values.

Qualifications

• Current Massachusetts nursing license in good standing (RN).
• Minimum of two (2) years of recent experience providing direct care to elders or adults with disabilities.
• Valid driver's license, reliable transportation, and proof of insurance.
• Willingness and ability to travel throughout assigned regions.
• Strong communication, interpersonal, documentation, and organizational skills.
• Ability to work independently while effectively managing multiple priorities.
• Strong problem-solving and critical-thinking abilities.

Preferred Experience

• In case management, home health, community health, adult foster care (AFC), group adult foster care (GAFC), behavioral health, or social services.
• Experience coordinating care and navigating community resources.
• Experience in English as a primary or secondary language.
• Experience working with diverse populations in community-based healthcare settings.