Registered Nurse, In-Home Health Assessments

Job Title: Community-Focused Registered Nurse (RN)

This community-focused Registered Nurse (RN) will travel to members' homes across Massachusetts to complete in-person health assessments for a managed care health plan's dually eligible members. The field based role specializes in conducting timely, accurate assessments and documenting findings, then handing off to the health plan's care management team. This is assessment and documentation work, not care plan development or ongoing case management.

Responsibilities:

• Conduct In-Person Assessments in the Field: Routinely travel to members' homes and or community settings to engage directly with members and perform required assessments (e.g., Uniform Core, Functional, and Comprehensive Assessments) evaluating physical, cognitive, and functional status while respecting cultural and linguistic needs.
• Comprehensive Care Management Documentation: Document assessment findings accurately in the health plan's care management platform (GuidingCare) following established workflows, and send prompt SOAP notes to the assigned Care Manager.
• Maintain High Quality & Timely Submissions: Submit complete documentation within 48 hours of each assessment, consistently meeting health plan quality standards and resolving any audit or review findings within two business days.
• Uphold Safety & Mandated Reporting Standards: Follow field-safety guidelines during independent home visits, escalate clinical or safety concerns appropriately, and adhere to state mandated reporter laws for abuse, neglect, or exploitation.
• Ensure Regulatory & Compliance Alignment: Adhere strictly to HIPAA privacy rules, NCQA standards, and applicable regulatory requirements while completing all ongoing mandatory training to maintain platform access.
• Other duties as assigned.