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Assessment Nurse Care Coordinator
Job Location:
Job Location:
Boston, MA - USA
Hourly Salary:
USD 40 - 58
Hourly Salary:
Posted:
21 October 2026 (5 days ago)
Posted:
Application Deadline:
18 January 2027
Application Deadline:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
Who We Are:
Since 1985 BHCHPs 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 11000 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 communitys most vulnerableand most resilientcitizens.
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.
Job Summary:
***NOW OFFERING A $4000 SIGN ON BONUS***
Hours: Monday - Friday 8:30am-5pm (Most work is in-person; however some remote hours may be possible. The hybrid schedule will be determined by the Program Manager)
Union: No
Union Name: N/A
Patient Facing: Yes
BHCHP is seeking an RN who is interested in flexible weekday hours and working on a small tight-knit team that provides care coordination services to clients enrolled in the BHCHP OneCare Program. The OneCare program is a state initiative to promote care coordination continuity of care and improved health outcomes for those clients under 65 who are eligible for both Medicare and this role you will mostly focus on performing Uniform Core Assessment (UCA) assessments and creating care plans customized to meet the needs of individual clients. UCA training is provided by Commonwealth Care Alliance (CCA)/CareSource. You will also help update these plans both annually and when a client has had a significant change in status. You will be required to conduct face-to-face outreach to meet with clients assess their status and support the clients progress toward better health outcomes. You will also connect with clients by phone communicate with providers about client needs and connect clients to eligible services including visiting nursing nutrition durable medical equipment and social services.
BHCHPs mission is to provide or assure access to the highest quality health care for all homeless men women and children in the greater Boston area. Clients may be housed; living in shelters or on the streets and this RN will need to be resourceful to connect with our clients. It is anticipated that success with connecting with clients will require communication with BHCHP care teams and shelter partners use of BHCHP and CCA/CareSource electronic medical records as well as outreach to clients who are living on the street shelter or in temporary or permanent housing.
Responsibilities:
Basic Knowledge/Skills:
***NOW OFFERING A $4000 SIGN ON BONUS***
Since 1985 BHCHPs 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 11000 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 communitys most vulnerableand most resilientcitizens.
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.
Job Summary:
***NOW OFFERING A $4000 SIGN ON BONUS***
Hours: Monday - Friday 8:30am-5pm (Most work is in-person; however some remote hours may be possible. The hybrid schedule will be determined by the Program Manager)
Union: No
Union Name: N/A
Patient Facing: Yes
BHCHP is seeking an RN who is interested in flexible weekday hours and working on a small tight-knit team that provides care coordination services to clients enrolled in the BHCHP OneCare Program. The OneCare program is a state initiative to promote care coordination continuity of care and improved health outcomes for those clients under 65 who are eligible for both Medicare and this role you will mostly focus on performing Uniform Core Assessment (UCA) assessments and creating care plans customized to meet the needs of individual clients. UCA training is provided by Commonwealth Care Alliance (CCA)/CareSource. You will also help update these plans both annually and when a client has had a significant change in status. You will be required to conduct face-to-face outreach to meet with clients assess their status and support the clients progress toward better health outcomes. You will also connect with clients by phone communicate with providers about client needs and connect clients to eligible services including visiting nursing nutrition durable medical equipment and social services.
BHCHPs mission is to provide or assure access to the highest quality health care for all homeless men women and children in the greater Boston area. Clients may be housed; living in shelters or on the streets and this RN will need to be resourceful to connect with our clients. It is anticipated that success with connecting with clients will require communication with BHCHP care teams and shelter partners use of BHCHP and CCA/CareSource electronic medical records as well as outreach to clients who are living on the street shelter or in temporary or permanent housing.
Responsibilities:
- Conducts UCA assessments for clients enrolled in the OneCare program.
- Collaboratively participates as a member of the primary care team that includes M.D.s N.P. /P.A. s Clinical RNs behavioral Health Clinicians Medical Assistants Case Managers and others.
- Communicates with clients and/or caregivers including performing outreach as necessary in the greater Boston area for face-to- face contact to homes hospitals other facilities etc. as needed to assess build relationships client status and identify new care needs.
- Uses CCA/CareSource and BHCHPs Electronic Medical Records (EMR) in a timely manner to note all client interactions and outcomes accurately and efficiently.
- Communicates clearly and professionally with other members of the interdisciplinary team as well as with clients and caregivers.
- Input authorizations for Durable Medical Equipment and other services (Home Health Aide Skilled Nursing Physical Therapy and Personal Care Attendant) based on UCA assessment.
- Bills for UCA assessments into BHCHPs EMR (EPIC) weekly.
- Supports the team with transitions of care as needed.
- Conforms to BHCHP standards of performance around client rights customer service infection control safety procedures and culturally competent care.
- Remains flexible in duties as role expands and is available for assistance with other projects as needed.
Basic Knowledge/Skills:
- Strong medical and surgical assessment skills.
- Interest in working with disadvantaged groups.
- Understanding of substance abuse and mental health.
- Excellent organizational and interpersonal skills.
- Experience with documenting in EMR is strongly preferred.
- Ability to work as part of a team and autonomously.
- Timely and strong communication skills via phone e-mail and internal secured messaging systems.
- Ability to prioritize and have attention to timetables to complete tasks.
- Experience with documenting in EMRs: EPIC Guiding Care and ECW strongly preferred.
- Must be able to work with and cooperate with multidisciplinary teams to achieve best patient care.
- Proficient with Microsoft Office Suite and ability to adapt to technological changes.
- Must be well organized efficient and can work autonomously and within a team.
- Drivers license a plus.
- Licensed as RN in Commonwealth of Massachusetts.
- Previous community health center or primary care experience.
- 1- 2 years RN experience preferred.
- Demonstrated interest in public health primary and preventive nursing and working with an under-served population.
***NOW OFFERING A $4000 SIGN ON BONUS***
- The compensation increases based on years of experience and ranges from $40.00 - $58.00 hourly.
- BHCHP full-time employees are eligible for our competitive time off program health dental and vision insurance 403B retirement savings planpre-tax MBTA pass program with 40% discount additional compensation for demonstrated bilingual proficiency and are prorated for part-time employees.
Does this amazing opportunity interest you Then wed love to hear from you.
As an equal opportunity employer Boston Health Care for the Homeless Program is committed to providing employment opportunities to all qualified individuals and does not discriminate on the basis of race color ethnicity religion sex gender gender identity and expression sexual orientation national origin disability age marital status veteran status pregnancy parental status genetic information or characteristics or any other basis prohibited by applicable law.
Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.
Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.
Required Experience:
Junior IC
About Company
With your support, BHCHP provides health care and hope to people experiencing homelessness in Boston and beyond. Learn more about us!
