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Seven Hills Foundation Registered Nurse MCCN in Worcester, Massachusetts

The RN is responsible for reviewing the information with the Enrollees, gathered in the

comprehensive assessment; reviewing the Enrollee’s care plan; conducting medication reviews and

providing oversight of LPN (not more than two) staff employed by MCCN; meeting weekly with

each LPN to review difficult cases; providing specialty Care Coordination with other medical

providers; and being available for both telephonic and in-person consultations for acute changes of

status in Enrollees.

  1. Provide medical consultation to MCCN team members and collaterals for acute changes of status in Enrollees.

  2. Liaison to and consult with the MCCN Medical Director.

  3. Conduct medication reconciliation during initial and annual Comprehensive Assessment; within (7) calendar days following Enrollee’s emergency department (ED) discharge; within (7) calendar daysafter an Enrollee’s inpatient discharge, discharge from twenty-four (24) hour diversionary setting, or transition to a community setting.

  4. Contact Assigned or Engaged Enrollee’s Primary Care Physician (PCP) to verify that medication orders from discharge are appropriate and that medication orders are filled correctly. Check for discrepancies and issues of medication non-compliance particularly in cases of multiple prescribers.

  5. Ensure that the Assigned and Engaged Enrollee demonstrates an understanding of medication administration and support adherence to their medication regime.

  6. Identify supports that are available or could be made available to support the Assigned or Engaged Enrollee in medication administration.

  7. Support Care Coordinator to ensure Enrollees have access to appropriate medical and specialty providers.

  8. Review and complete medical sections of Assigned or Engaged Enrollee’s comprehensive assessments, and review LTSS sections completed by the care coordinator.

  9. Participate in MCCN team meetings to ensure effective communication among all disciplines.

  10. Participate in all required orientation and training and assist with training other staff on the CP Team.

  11. Learn all MCCN policies, procedures, protocols, and plans and deliver services and consultation in compliance with them. Assist with training other staff on the CP Team.

  12. Coach CP Care Team and provide supportive knowledge about LTSS CP priority population, diagnosis, and health risk factors.

  13. Learn evidence-based practices identified by MCCN, and deliver CP supports and activities in compliance with them and assist with training other CP Team members.

  14. Utilize a person-centered approach when planning and delivering services in partnership with all enrollees, associated support systems such as family members, friends, guardians, and all medical and behavioral health providers.

  15. Anticipate issues of medical risk and attend to crisis or emergency situations by intervening immediately with appropriate clinical/medical treatment and/or supervision. Develop medical protocols for individuals as needed.

  16. Complete all required documentation in a timely manner.

  17. Demonstrate a proactive commitment to maintaining effective communication with staff, Enrollees, Care Team members and other collaterals. Promote strong working relationships and excellent customer service.

  18. Complete required trainings and other professional development activities.

  19. Strictly adhere to HIPPA and confidentiality policies at all times, including when responding to inquiries for Enrollee information

  20. Attend and actively participate in supervision and staff meetings.

  21. Maintain current certifications and licenses

  22. Ensure that all clients are treated with dignity and respect in accordance with MCCN’s Human Rights policy.

  23. Perform all duties in accordance with the agency’s policies and procedures.

  24. Strictly follow all agency Performance Standards

  25. Registered Nurse licensed in the Commonwealth of Massachusetts with minimum of 4 years of experience working with adults in a community-based mental health, substance use and/or physical health setting

  26. Demonstrated knowledge base and judgment necessary for independent clinical decision making.

  27. Excellent verbal and written communications skills. Strong interpersonal and customer relations skills required.

  28. Ability to use Electronic Health Records (EHR) Systems to document and coordinate services.

  29. Excellent organizational, time management and problem-solving skills.

  30. Strong computer knowledge, including proficiency in contemporary Windows operating systems and Windows office suites with an emphasis on Word and Excel; ability to learn new systems; experience entering and working with data; and comfort and experience using mobile technologies.

  31. Knowledge regarding psychiatric rehab and understanding of recovery model.

  32. Strongly prefer that a candidate will have a demonstrated understanding of and competence of Health Equity and in serving culturally diverse populations.

  33. Must be able to perform each essential duty satisfactorily.

  34. Must hold a valid drivers’ license. Must have access to an operational and insured vehicle and be willing to use it to transport members.

  35. Must have ability to read English and communicate effectively in the primary language of the program to which he/she is assigned.

ID: 25001

Schedule: M-F

External Company Name: Seven Hills Foundation

External Company URL:

Street: 81 Hope Avenue

Telecommute: Yes