Position Summary:

SUD RN Nurse Care Manager report to the Manager of Care Management in the Complex Care Nursing department and will also receive supervision and further direction from the Clinical Program Supervisor for Substance Use Disorder Services. This role will be a member of the Substance Use Disorder Services team and will work collaboratively to care for patients at the health center with SUD.

This role will provide clinical care, leadership and quality improvement in substance use disorder screening, referral and treatment including coordinating and providing clinical care for patients in the Medication Assisted Treatment (MAT) Program.

Care Management

• Coordinate care for patients with substance use disorder including new and current patients involved in the CSHC MAT program.
• Develop individualized patient care plans for patients with opiate use disorders in collaboration with MAT program team members
• Educate patients, families, and healthcare providers on how to follow and maintain their care plans.
• Collaborate with CHWs, SUD Outreach team and other health center staff to link patients to community-based services to address patient needs
• Makes referrals to addiction services to assist patients with access to outside addiction resources when appropriate including detoxification, inpatient, IOP/SOAP, AA/NA and methadone programs.
• Assist patients in navigating the health care system. Coordinate specialty care, follow-up on test results and other care coordination needs to patients and providers.

Direct Patient Care

• Adhere to all aspects noted in the job description for a registered nurse.
• Coordinate and manage scheduled nurse visits.
• Conduct comprehensive assessments of patients’ physical, mental, and psychosocial needs at nurse visits.
• Assesses and monitors patients in the induction, stabilization, and maintenance phases of MAT treatment.
• Documents patient progress in the EMR using templates as appropriate
• Utilizes behavioral strategies to help patients adopt healthy behaviors and improve self-care. Promote self-management goals, decrease risk status, and minimize hospital and ED utilization.
• Ensure collaborative communication with care teams, coordinate specialty care and follow up visits.

Administer injectable long-acting medication for substance use disorders

• Order injectable long-acting medication prior to visit and coordinate timely delivery
• Maintain stock of injectable medications through adhering to protocols
• Assists with prior authorization when necessary for MAT medication
• Files reports and updates MAT databases as needed.

All other duties as assigned.

• Registered Nurse licensed in Commonwealth of Massachusetts (BSN required).
• Experience in addiction, substance use disorder management required.
• Detail oriented.
• Demonstrates excellent communication
• Sensitivity to ethnic, cultural, gender; beliefs, and behaviors.
• Multi-lingual is preferred.