Home Care Nurse Manager

Job Description

Job Description

Description:

Position Summary:

The Nurse Manager is a vital Home Care (HC) department leadership team member responsible for administrating, managing, and overseeing all nursing-related, intensive case management, care transition activities, and initial assessment activities. As such, this position is integral in determining and monitoring client eligibility for State HC and Medicaid-funded programs and screening activities based on nursing and case management assessment data, regulatory and compliance oversight, and active participation in interdisciplinary case conferences. This position will directly supervise nurses, community transition liaison, and administrative support staff. Additionally, as part of HC’s leadership team, the nurse manager provides clinical expertise and functions as an agency consultant and trainer regarding mental and physical health issues of aging, social determinants of health, and care coordination. The Nurse Manager must be skilled at program implementation and evaluation, identifying and implementing strategies to enhance the department’s clinical skills, spearheading department compliance initiatives, and decreasing agency silos.

WHY JOIN SCES?

At Somerville-Cambridge Elder Services (SCES), we are committed to helping older adults and adults with disabilities live with dignity, independence, and connection in the setting of their choosing. Our work is mission-driven, person-centered, and grounded in compassion, equity, and community.

Joining SCES means becoming part of a collaborative, innovative organization where your expertise directly improves lives every day. You will work alongside dedicated professionals who are passionate about strengthening community-based care, supporting caregivers, and helping individuals age safely and successfully in their homes and communities.

SCES also prioritizes employee wellbeing and sustainability. We recognize that supporting our staff is essential to supporting our community. Employees benefit from:

· Hybrid work environment

· 35-hour work week

· Competitive compensation

· Mission-driven culture

· Supportive leadership and interdisciplinary collaboration

· Opportunities for professional growth and community impact

· Greater schedule flexibility and autonomy than many traditional nursing roles

If you are looking for a career that combines clinical expertise, purpose, flexibility, and meaningful human connection, we encourage you to join our team.

Responsibilities

· Lead the implementation, operations, compliance, and continuous improvement of the Intensive Case Management Program, Clinical Assessment & Eligibility (CAE), State Home Care, and CSSM/CTLP programs in accordance with agency, MassHealth LTSS, and Executive Office of Aging & Independence (AGE) requirements.

· Serve as the primary liaison to the Executive Office of Aging & Independence and MassHealth Office of Long-Term Services and Supports for assigned programs and initiatives.

· Provide clinical leadership, supervision, coaching, performance management, and professional development to nursing and Home Care staff to ensure high-quality service delivery and regulatory compliance.

· Deliver clinical consultation, risk assessment, safety planning, and care transition support for medically, behaviorally, and socially complex consumers, including hospital and skilled nursing facility discharges.

· Partner with interdisciplinary teams, Protective Services, hospitals, SNFs, vendors, AFC, FCSP, and community providers to support safe transitions of care, complex caregiving situations, and high-risk consumer needs.

· Oversee enrollment, eligibility, utilization, and program spending for CSSM/CTLP, waiver, and enhanced Home Care programs; ensure timely follow-up and appropriate level-of-care transitions.

· Monitor quality, compliance, documentation, and visit requirements through audits, reporting, supervision, and performance tracking systems; support agency quality improvement initiatives and corrective actions.

· Develop and implement policies, workflows, staff education, and clinical training programs aligned with AGE, MassHealth, compliance findings, and operational priorities.

· Provide training and clinical guidance on topics including fall prevention, home safety, dementia care, medication management, habilitation therapy, and complex care coordination.

· Build and maintain strong partnerships with hospitals, skilled nursing facilities, community providers, and referral sources to strengthen collaboration, referral quality, and program awareness.

· Collaborate across departments on outreach, referral development, community engagement, and strategies to support high-risk consumers and caregivers.

· Create educational and marketing materials related to eligibility, referral pathways, and Home Care program services; provide external stakeholder training as needed.

· Support engagement strategies for consumers experiencing mental health and/or substance use challenges to improve participation in Home Care services.

· Conduct nursing assessments, home visits, family meetings, discharge planning meetings, and care transition activities as needed.

· Ensure timely, accurate, and confidential completion of all clinical documentation, reporting, incident reporting, and regulatory submissions.

· Analyze program data and outcomes to identify opportunities for operational improvement, enhanced care coordination, and reduced barriers to discharge and service access.

· Participate in Fair Hearings, appeals, agency on-call coverage, and other agency responsibilities as assigned.

Professional Standards and Conduct:

Collaborative and Responsive: Regularly communicates, follows up, and uses a team-driven approach. Responds thoughtfully and promptly to agency and client needs, requests, and inquiries and identifies and builds partnerships with key internal and external stakeholders. Has excellent organizational and time management skills to meet various deadlines, ensuring closed-loop communication, multi-tasking, and flexibility. Regularly collaborates cross-departmentally to serve our clients best and support the HC department staff.

Communication: Strong written and verbal communication skills, focusing on clear and concise communications with internal and external stakeholders, providers, and departmental staff. Comfortable with boundary setting, de-escalation, and clarifying roles and expectations to vendors, providers, clients, and caregivers in a respectful and courteous manner. Excellent public speaking and presentation skills.

Analytical: Strong attention to detail. Able to apply critical thinking, coordination, and problem-solving skills to ensure program compliance requirements are met and clients receive high-quality care. Is proactive in identifying areas for improvement and implementing training and processes to support staff around clinical needs and ongoing skill development and compliance efforts. Reviews and interprets directives and requirements from stakeholders such as EXECUTIVE OFFICE OF AGING AND INDEPENDENCE (AGE) and MassHealth and follows up in a proactive, solutions-focused manner.

Attendance and Punctuality: Dependable, punctual, showing flexibility when needed. Attends meetings as needed and is fully present and participates during those meetings.

Commitment: Embodies SCES’s core values and shows great integrity, accountability, and professionalism. Aids in furthering SCES’s mission and commitment to an inclusive environment.

Qualifications:

· Graduation from a School of Nursing accredited by the National League for Nursing required ; B.S.N. required . M.S.N preferred . Valid license as a registered nurse in the Commonwealth of Massachusetts is required .

· At least three years of full-time or equivalent experience as a registered nurse in a community setting is required.

· At least one year of supervisory, administrative, or managerial experience is required. Additional experience beyond one year is strongly preferred. Clinical supervision experience is a plus.

· Previous experience with the older adult population, mental health, care coordination, and/or community health settings required . Aging Services Access Point (ASAP) experience is strongly preferred . Knowledge of the State Home Care system, MassHealth LTSS programs, and/or community resources is strongly preferred.

· Must be knowledgeable and comfortable using Adobe and MS Word, Excel, PowerPoint, SharePoint, and other Microsoft 365 platforms. Experience with Wellsky is strongly preferred .

· Experience with compliance monitoring and tracking is strongly preferred . This may include but is not limited to quality assurance, reporting, audits, and training. Ability to interpret regulatory and business processes and develop and implement policies and procedures required.

· Must receive certification in Habilitation Therapy within the first 6 months of hire.

· Valid driver’s license required. Must be able to travel to consumers’ homes, area hospitals, and nursing homes via public transportation or by car.

· Meets both CORI/SORI and public health screening requirements.

Salary Range $100,000 - $125,000 DOE

Physical Environment

· Physical surroundings are comfortable with minimal exposure to injury or hazards.

Social/Psychological Conditions

· Occasional stress due to periodic or cyclical workload pressures and deadlines. Some interruptions involved.

· Frequently sits throughout the day.

· May lift, pull, and carry up to 20 lbs.

· Periodic eye strain and light ear strain.

Physical Effort

· Frequently sits, stands, walks, bends, reaches, and stoops throughout the day.

· Frequently lifts, pulls, pushes, and carries up to 20 lbs.

· Periodic eye strain and light ear strain.