Registered Nurse; MA​/Field Based

Freedom Care is a healthcare company that has been dedicated to revolutionizing the home care industry since 2016. We support our patients by ensuring they have the power to choose a caregiver who will care for them in the comfort of their own homes. Our mission spans coast to coast, supporting patients across the U.S.

We pride ourselves on our values which drive the level of care that we deliver to our patients:

• Here For You (An attitude of service, empathy, and availability)
• Own It (Drive and ownership)
• Do the Right Thing (High integrity)
• Be Positive (Great attitude and a can-do positive approach to challenges)

Join our team and make a positive impact on the lives of others! We are looking for a Care Manager, RN for our Massachusetts team
!

Freedom Care’s Massachusetts operations support the Mass Health Adult Foster Care (AFC) program, which helps eligible adults with medical, physical, cognitive, or behavioral health needs receive daily assistance in a home setting from a qualified caregiver with professional care team support.

The Care Manager, RN is responsible for conducting initial in-home assessments, orientations for new patients and caregivers, and providing ongoing care management and support. This role combines clinical assessment, care coordination, patient and caregiver education, and quality assurance to ensure safe, effective, and person-centered care.

The Care Manager, RN collaborates closely with patients, caregivers, and interdisciplinary care teams to assess needs, develop individualized plans of care, and facilitate the seamless initiation and delivery of services. Through regularly scheduled home visits, the RN completes and coordinates applicable clinical assessments and evaluations; develops, implements, monitors, and reviews member plans of care; monitors member health status; provides clinical oversight, education, support, and evaluation of AFC caregivers;

and coordinates care with the member, responsible party, care manager, primary care provider, and other service providers. The Care Manager, RN proactively communicates clinical concerns, changes in condition, and potential barriers to care with the appropriate team members to ensure timely intervention, effective care coordination, and optimal patient outcomes.

• Conduct initial in-person clinical assessments and coordinate timely service activation, ensuring all required documentation, approvals, and standard procedures are completed.
• Develop, implement, and manage individualized plans of care, making and documenting revisions as the patient’s needs or condition change.
• Educate patients, caregivers, and internal teams regarding care needs, safety considerations, service requirements, caregiver responsibilities, and next steps.
• Coordinate patient care through timely communication and documentation with physicians, clinical disciplines, internal partners, and appropriate community resources.
• Provide ongoing education and coaching to support effective use of established best practices, promote caregiver competency, and connect patients and families with appropriate resources.
• Review caregiver documentation regularly and respond appropriately to identified changes in the patient’s condition, environment, or service needs.
• Identify changes in condition, safety concerns, service gaps, incidents, or other urgent issues and elevate them in accordance with established clinical protocols.
• Complete and…