Per Diem Registered Nurse (RN)

Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,500 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in over 550 sites throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers.

The Medical Per Diem RN (Integrated Care) provides support to the team function of care coordination and care management for MassHealth Members with complex medical and behavioral health needs who are enrolled in an Accountable Care Organization (ACO) or Managed Care Organization (MCO) plan.

The Per Diem RN may be responsible for the follow responsibilities: Performs outreach to and engages Enrollees of an ACO plan as referred to Community Partners Program. Coordinates the completion of the Comprehensive Assessment (CA), including the approval of medical sections, as required of RN. Conducts initial and ongoing risk assessment; designs personal crisis management plans, relapse prevention, and harm reduction strategies with members who have been identified as medically complex, in collaboration with team. Coordinates the development, implementation, and ongoing review of the Person-Centered Treatment Plan (PCTP), inclusive of any LTSS and / or SDH needs or goals of the Enrollee. Collaborates closely with PCP and other providers to assure appropriate referrals based on level of care needed to optimize health outcomes and minimize risk. Collaborates with ACO Plan, PCP, and other health care providers regarding changes in services, care transitions, and crisis intervention while focusing on continuity and quality of client care. Obtains required Prior Authorization from ACO/MCO Plan for relevant/necessary services. Manages care transitions through collaboration with Enrollee, community provider staff, ICT, and hospital staff to ensure a safe discharge plan and a well-coordinated implementation of that plan. Ensures for medication review and reconciliation as triggered by a care transition or by a medication change through an outpatient medical or psychiatric visit. Performs other related duties, as required.