Field Registered Nurse

• Complete medical and/or behavioral health assessments within contract requirements
• Conduct on-site, video call, and/or telephonic assessments to determine members’ needs, service eligibility, level of care, and related outcomes
• Conduct comprehensive in-person assessments in members’ homes, hospitals, and community settings
• Use standardized tools such as UCA and TTT to identify medical, functional, behavioral health, and social needs
• Develop and manage person-centered service plans for complex or high-acuity members
• Coordinate with healthcare providers, case managers, community partners, and care teams
• Evaluate eligibility for referrals to other professionals or agencies
• Revise care plans as members’ needs change and align them with member goals
• Educate members, families, and caregivers about available services and options
• Document assessments and care activities accurately for billing, compliance, and quality reporting
• Maintain compliance with state and federal regulations, Medicaid/LTSS guidelines, HIPAA, and company confidentiality policies
• Advocate for members to remain in preferred living environments and maintain independence
• Travel throughout an assigned Massachusetts service region
• Perform other related duties as assigned

• Current, active, unencumbered Registered Nurse (RN) license in Massachusetts
• High School Degree or equivalent
• Minimum 2 years of relevant post-graduate clinical experience as a Registered Nurse
• Experience working with vulnerable populations, including behavioral health, intellectual and developmental disabilities (I/DD), and long-term services and supports (LTSS)
• Experience conducting clinical or functional assessments in home or community-based settings
• Knowledge of community-based services, care coordination, and person-centered care planning
• Familiarity with Mass Health programs, LTSS, and Home and Community-Based Services (HCBS) waiver programs
• Proficiency in Microsoft Office applications
• Experience documenting assessments in electronic systems
• Compliance with Person First standards, HIPAA guidelines, and company confidentiality policies
• Reliable high-speed internet service
• Minimum 20 Mbps download speed and 50 Mbps for shared internet connectivity
• Minimum 5 Mbps upload speed
• Private and secure workspace
• Ability to reliably commute to the assigned Massachusetts territory if residing in a neighboring state

Demonstrates expertise in conducting comprehensive medical and behavioral health assessments, developing person-centered service plans, and ensuring compliance with state and federal regulations. Proficient in coordinating care with healthcare providers and community partners while advocating for member independence.

• Registered Nurse (RN) License
• Clinical Assessment Experience
• Person-Centered Care Planning
• Knowledge of Mass Health Programs
• Compliance with HIPAA Guidelines

• Medical Assessments
• Behavioral Health Assessments
• Care Coordination
• Service Plan Development
• Documentation in Electronic Systems

• Advocacy
• Communication
• Collaboration

• Registered Nurse (RN) License in Massachusetts

• Long-Term Services and Supports (LTSS)
• Home and Community-Based Services (HCBS)
• Person First Standards
• Vulnerable Populations

• Microsoft Office Applications
• Standardized Assessment Tools (UCA, TTT)