About the Role: The RN Case Manager for the Pearl Team program plays a crucial role in coordinating comprehensive care for patients with substance use disorders. This position is responsible for developing individualized care plans that address the unique needs of each patient, ensuring they receive the appropriate medical, psychological, and social support. The RN Case Manager will collaborate with a multidisciplinary team to facilitate access to resources and services, promoting recovery and improving overall health outcomes. By providing education and support, the RN Case Manager empowers patients to take an active role in their treatment journey. Ultimately, this role aims to enhance the quality of life for patients while reducing barriers to care and fostering a supportive environment for recovery. Minimum Qualifications: • Graduate of an accredited nursing program. • RN with current Mass. Licensure • Previous experience in Community Health or Nurse Case Management preferred • Bilingual in Spanish/Khmer/Russian beneficial • History of good attendance and positive work attitude Preferred Qualifications: • Certification in Case Management (CCM) or a related specialty. • Experience working with patients in substance use treatment programs. • Knowledge of community resources and support services for individuals with substance use disorders. Responsibilities: • Establish contact with patients appropriate for RN Case Management due to diagnosis, treatment regime, risk status, compliance, recent ER usage or Grant specified target group criteria. • In collaboration with the PCP, Team RNs, Clinical Pharmacist, other Providers, patient and family formulate a plan of care that supports best practice and guides the patient in achieving identified/revising Self Management goals.This plan may include medication management, diet counseling, exercise, referral for specialty care, education for proper use of medical equipment or supplies, update of immunizations, group or individual education and support. • Coordinate with other departments and agencies to best meet patient needs (i.e. Enrollment, Social Services, WIC, HAWC, BH, SBHC, Dental, Eye, Pharmacy etc.) • Assure that patients are scheduled for follow up, lab or other pertinent visits and receive periodic phone calls to support their health maintenance activities. Provide for follow up of no shows. • Consistently use the learning assessment, appropriate teaching guidelines, plan of care, EHR/EPM to review and document patient interventions. Skills: The required skills for this position include strong assessment and critical thinking abilities, which are essential for developing effective care plans tailored to each patient's needs. Excellent communication skills are vital for collaborating with a multidisciplinary team and for educating patients and their families about treatment options. Organizational skills are necessary to manage multiple cases efficiently and ensure timely follow-up with patients. Preferred skills, such as knowledge of community resources, enhance the RN Case Manager's ability to connect patients with additional support services. Overall, these skills contribute to a comprehensive approach to patient care, fostering a supportive environment that promotes recovery and well-being. Monday - Friday, 8:30 a.m. to 5:00 p.m. 40 Hours