Nurse Case Manager, Outreach

Who We Are:

Since 1985, BHCHP's mission has been to provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. We care for over 11,000 homeless individuals each year and ensure that every one of these individuals can receive comprehensive health care, which includes primary care, behavioral health, medical respite, dental, case management, and more.

Our staff work in 30+ locations across the city to serve some of our community's most vulnerable-and most resilient-citizens.

From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity, centering trust, mutual respect, hope, and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down physical and systemic barriers that our patients face and provide community-based health care services that are compassionate, dignified, and culturally appropriate.

*** NOW OFFERING A $4,000 SIGN ON BONUS***

Hours:

Monday - Friday, 8:00 am-5:30 pm - full-time or part-time schedule possible
Union:
No
Union Name: n/a
Patient Facing:
Yes

Are you an RN looking for an opportunity to combine clinical nursing with meaningful community outreach?

We are seeking an HIV Nurse Case Manager to join a dynamic, multidisciplinary HIV primary care team nationally recognized as a model of excellence.

In this role, you will build trusting relationships with patients and provide compassionate, non-judgmental nursing care across a variety of settings—including outpatient clinics, shelters, drop-in centers, street outreach locations, and patients' homes. Working alongside medical providers, case managers, social workers, behavioral health professionals, and other nurses, you will help ensure that patients receive coordinated, comprehensive care wherever they are.

Your clinical responsibilities will include HIV and chronic disease management, nursing assessment, triage, care coordination, medication adherence support, health education, and behavioral risk-reduction counseling. You will respond to both routine and urgent patient needs and help ensure clear communication and continuity of care across the multidisciplinary team.

This is an opportunity to take nursing beyond the traditional clinic setting and make a lasting impact by connecting people experiencing homelessness and living with HIV to care, supporting ongoing engagement and retention in treatment, and helping patients achieve and sustain their health and wellness goals.

This position is funded until the end of March 2028 with the possibility for renewal. If this funding is not renewed, this position will end March 31, 2028.

• Provides outpatient primary care nursing including medical assessments and triage services for HIV team patients coming in for same-day or scheduled visits; conducts virtual, telephonic, or in-person nurse assessment and triage to assess the severity of the patient’s health concerns using approved protocols and resources to advise appropriately. Documents patient information accurately and in a timely manner in the EHR.
• Implements the patient-centered plan of care, evaluates outcomes, and regularly communicates the plan of care, patient status, and progress toward goals with the patient and care team members; conducts comprehensive intake assessments for new HIV team patients.
• Administers vaccines, injectable medications, and provides wound assessment and wound care as indicated; provides medication adherence assessments and counseling. Provides directly observed therapy when indicated with support of outreach team members.
• Coordinates care with integrated HIV team behavioral health staff. Along with other team members, visits patients at shelters and other outreach sites to provide nursing care and care coordination services and identify barriers to medication adherence and engagement in care.
• Provides chronic disease management support for HIV as well as other common co-morbid medical conditions such as diabetes and hypertension. Identifies any structural barriers patients face in accessing medical care and adhering to HIV medications, and works with the interdisciplinary team to address those barriers (e.g., housing, transportation, drug treatment, food, clothing, benefits, etc.)
• Assists medical providers in coordinating…