Staff RN/ 40 HRS Days Variable/Rotating/ Bilingual/ BWH Primary Care- Longwood

Wentworth-Douglass Hospital Boston , MA 02298

Posted 6 months ago

Excellent Care to Patients and Families The Best Staff In the Safest Environment

Nursing at Brigham and Women's Hospital is known for their excellent clinical practice and for keeping patients and their families at the center of all they do. We understand that great care is shaped by relationships with patients and their families. That's why we're committed to knowing our patients on a deeper level not just as patients, but as individuals to ensure that they, and their families, feel known and cared for.

At BWH, we proudly work together with a spirit of inquiry and a deep commitment to providing the highest quality, evidence-informed and theory-guided care in an inclusive environment. We work each day to achieve our vision to provide excellent care to patients and families, with the best staff, in the safest environment.

Just as we have been able to reinvent health care, we have also transformed health care careers. Whether measured in terms of lives saved, awards earned, or the personal satisfaction of stretching your talents a career with BWH is unlike any other in the health care field. Here you'll find a workplace where collaboration and teamwork are the norm, not the exception physicians, nurses, technicians, staff and management form a close-knit bond, based on mutual respect and devotion to our patients. If you want an enormously fulfilling career, there's no better place to be.

The Staff Nurse will be responsible for:

  • Providing care for patients in Primary Care

  • Working collaboratively to provide excellent care to patients and families in the safest environment.


The Primary Care Registered Nurse (staff RN) is an important member of the primary care multi-disciplinary team. Patients, families and the health care team work best as partners with shared goals for attaining optimal health and wellness. The RN is integral to providing the support and care necessary to achieving such goals. The primary responsibility of the staff RN is to provide excellent care to patients and families. The role requires the provision of care that is comprehensive and compassionate, delivered to a diverse, medically and socially vulnerable population. Role responsibilities within this setting are defined below.

1 . Patient Care Organization

  • May perform all duties as described in the Brigham and Women's Registered Nurse Job Description to meet direct care requirements of the role.

  • Functions effectively and safely within the scope of practice of the Registered Nurse to strengthen the practice and provide patient centered care.

  • Provide culturally sensitive, patient centered care of the highest quality to patients of all backgrounds and income levels.

  • Triages all urgent calls and assists with walk-ins. Sets priorities when organizing care based upon the acuity. Is aware of clinic flow and re-arranges provider schedules to accommodate the urgent care needs

  • Assesses the care needs of patients with routine and chronic illnesses. Develops implements and re-evaluates an individualized nursing plan of care (PoC).

  • Within a multi-disciplinary team, assists patients with pre-existing conditions to achieve lifestyle changes that promote a healthy mindbodyspirit.

  • Uses a variety of modalities to engage patients including nurse visits, telephonic and electronic communication (Gateway/Telehealth).

  • Operating from a Human Caring framework, the RN implements a wide range of interventions/skills including coaching, education, counseling, motivational interviewing, referral and advocacy to services and resources as appropriate to promote health and wellness.

  • Responsible for evaluation and documentation of disease management impact. Works closely with the clinical team and family to promote self-management and ensure a cycle of continuous refinement of PoC which includes education for the patient and family, utilizing appropriate resources.

  • Demonstrates knowledge of community resources and assists staff, patients, and families to effectively utilize them.

  • Ensures effective coordination of care across the care continuum. Works with Partners, Brigham Health and Community partners including; home care, outpatient clinics, emergency/urgent care and hospital settings.

  • Knowledge base should include basic health teaching, family planning education, and how to care for common pediatric/ adult illnesses.

  • Facilitates the advanced care planning process, assisting patients and families to consider options and goals for future healthcare decisions. Documents advanced care goals in the EHR.
    2.Team Based Care

  • Serves as a resource person to other members of the team around the care needs of patients and provides support to other members of the clinical and administrative team in an accessible, open manner. Willing to educate and mentor clinical support staff as needed. Is able to delegate safely and effectively to support staff tasks that are within scope of practice.

  • Coordinates care across members of the team in accordance with patient care needs, team member capabilities and qualifications, utilizing team members strategically to provide safe and effective care at the top of licensure, education and training.

  • Evaluates effectiveness of care given by the multi-disciplinary care team, identifies problems and guides members toward solutions promoting health. Facilitates the improvement of the patient's ability to self-manage prevention and behavioral health issues and placing emphasis on transitional care, prevention, and wellness.

  • Communicates effectively and clearly with members of the care team regarding patient status and needs.
    3.BWH Professional Practice Model Qualities:

BWH Primary Care Registered Nurses practice from a Human Caring framework using the Caritas Processes and demonstrating the tenants of the Professional Practice Model:

  • Nurses as Authentic Leaders

  • True Collaboration

  • Meaningful Recognition, participates in peer feedback.

  • Scholarship

  • Relationship Based Care

  • Outcome Focused Measures
    4.Participatory Management of Fiscal Responsibilities

  • Utilizes time and materials in an effective and economical manner.

  • Provides suggestions which support the delivery of cost effective healthcare to patients and families.

  • Assesses patient's acuity accurately when making decisions regarding clinical bookings, appropriate level of service and staffing.

  • Is familiar with accountable care regulations and demands

To qualify you must have:

Education: Graduate of an approved school of nursing with current registration in Massachusetts. For newly licensed nurses a Bachelor of Science Degree in Nursing is required.


  • Three years of Primary Care experience preferred

  • Recent Ambulatory Care experience required (Surgical/Procedural excluded)

  • Bilingual Spanish - English required.

  • Previous experience with medical residents preferred. Desire to work with nursing students and medical trainees is essential.


  • Must meet all skills and abilities requirements on the BWH RN job description and additionally:

  • Demonstrated knowledge of both hospital-based and community-based care and resources required.

  • Bilingual English/Spanish speaking required

  • Clinical knowledge and expertise includes basic health teaching, family planning education, knowledge of advanced care directives, care for common illnesses.

  • Excellent communication skills, professionalism and organization required, demonstrates patience, compassion.

  • Excellent analytical, judgmental, and interpersonal skills and demonstrated ability to work effectively with patients, families and co-workers

  • Certified Diabetic Educator preferred /Interest in becoming a CDE

  • Motivational interviewing/Health Coach Certificate preferred /willing to achieve within two years of hire

  • Technical dexterity, in addition to Epic, must possess a demonstrated ability to work with a variety of information systems and databases, including but not limited to: MS, Access, Excel - required

  • Ability to be flexible and maintain equanimity in a fast paced, rapidly changing clinical setting required.

  • Must have the ability to function at the highest level professionally and clinically and further possess excellent interpersonal skills.


  • Membership in professional organizations is recommended and certification in a specialty area is encouraged.

  • Able to work weekend rotation per the MNA contract

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Care Coordinator (Case Manager) / 40 Hours / Variable Rotating BWH Care Coordination

Brigham And Women's Hospital

Posted 1 week ago

VIEW JOBS 10/13/2019 12:00:00 AM 2020-01-11T00:00 GENERAL SUMMARY/ OVERVIEW STATEMENT: Position Summary The RN Care Coordinator (RNCC) manages a caseload of patients and is responsible for ensuring care that supports desired clinical and financial outcomes. Has the skills and knowledge specific to the unique needs of assigned patients. Coordinating the care prescribed by an interdisciplinary team, the RNCC utilizes patient assessment, care guidelines, protocols, payer regulations and response to therapies to assess the episode of illness from pre admission to post discharge. Participates in the ongoing evaluation of practice patterns and systems and supports efforts to improve quality, cost and satisfaction outcomes. Mobilizes resources to maximize efficiency of care delivery. PRINCIPAL DUTIES AND RESPONSIBILITIES: Principle Responsibilities A. Care Facilitation Coordinates and insures implementation of the plan of care, utilizing case management principles. * Prior to or within 24-48 hours of admission the RNCC, by interview of the patient/family, discussion with physician team and/or attending MD and other team members, develops a provisional treatment program and tentative discharge date. * Reviews daily treatment plan with physicians, nurses and patient / families to insure interdisciplinary communication and coordination is occurring. * Participates with nursing staff and physicians in patient care rounds to contribute to plan of care and monitor and report patient progress. * Collaborates with other departments to expedite sequencing and scheduling of interventions, consults, treatments and ancillary services. * Provides for daily continuity with patients to assure patient needs related to discharge are met. * Incorporates knowledge of utilization management principles and payer contracts into patient plans of care. Keeps physicians and nurses informed of implications. * Presents alternatives to inpatient stay to attending MD, team and patient / family based on assessed patient level of care and insurance benefits * Seeks assistance and/or consultation from Care Coordination leadership with plans for outlier and potential or actual resource intensive patients. * Interacts with internal and external health care providers to facilitate patient care including post discharge services * Contributes to the development, implementation and monitoring of practice guidelines. * Identifies attending, resident and nurse learning needs related to case management and works with service leaders to develop educational plan. B. Discharge Planning Coordinates and executes the discharge planning process for patients, ensuring each patient has a discharge plan. * Assesses continuing care needs in conjunction with other caregivers. * Coordinates and schedules interdisciplinary meetings with the patient and family regarding discharge needs and plan as appropriate. * Assures patient education consistent with discharge plan has occurred. * Identifies service, treatment and funding options for post-hospital care. * Promotes interdisciplinary patient/family communications and documentation that facilitate discharge planning striving to finalize plans the day prior to discharge. * Performs patient/family follow-up after discharge to monitor and support desired outcomes. * Initiates contact with home health agencies and extended care facilities to insure prompt and effective transition of care. C. Utilization Management Collaborates with appropriate individuals, departments, and payers to insure appropriateness of admission, continued days of stay, and reimbursement. * Identifies patients who are likely to have unmet insurance and resource needs and communicates with and/or makes referrals to other members of the health care team and other appropriate departments. * Communicates as needed with third party payers regarding patient's progress with treatment plan. * Identifies need for and issues Medicare notices of non-coverage, providing appropriate documentation of the process and communication to patient/family and other members of the health care team * Utilizing industry accepted utilization and/or medical management criteria (InterQual) identifies, monitors and reports variances from established treatment plan, including appropriateness of admission, continued stay, delays in treatment, and discharge plan. * Conducts documented utilization reviews to insurers or intermediaries. * Identifies SNF and AND days for Medicare and Medicaid patients. * Initiates actions concurrently to reduce and/or eliminate inappropriate hospital admissions and days, and system delays. * Works with payers and physicians to concurrently address level of care concerns effecting claims and reimbursement. * Contributes to utilization and practice improvement efforts by reviewing reports with colleagues and providing feedback on utilization trends and payer issues. * Serves as the primary patient information source to third party payers. QUALIFICATIONS: * Education: Graduate of an approved school of nursing with current registration in Massachusetts. For newly licensed nurses a Bachelor of Science Degree in Nursing is required. * Two years of experience with discharge planning, knowledge of community resources and patient education principles as a case manager is required. * Knowledge and skills to differentiate levels of care is required. * Five years of previous acute care experience in related clinical specialty preferred. * Two or more years experience with hospital utilization review and medical criteria sets preferred. * Certification in case management preferred. SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: * Previous experience in a hospital or health care setting * Bilingual (English/Spanish) preferred * Strong clinical assessment skills * Excellent interpersonal skills including ability to work collaboratively and cooperatively within a team and with internal and external customers * Strong organizational skill and ability to set priorities * Ability to compile data from concurrent and retrospective medical record review to determine clinical appropriateness, able to demonstrate the ability to meet a patient's needs based on their clinical diagnosis, level of care and discharge plan * Ability to negotiate several aspects of care coordination simultaneously; excellent written and verbal communication skills WORKING CONDITIONS: Works in a busy and at times stressful hospital and office environment. Must be flexible and able to work well independently Brigham And Women's Hospital Boston MA

Staff RN/ 40 HRS Days Variable/Rotating/ Bilingual/ BWH Primary Care- Longwood

Wentworth-Douglass Hospital