Location: Danvers
Department: Clinical
All Care is seeking a Nurse Case Manager for its Frail Elder Program, a partnership with Aging Services Access Points (ASAPs). This program supports adults age 60+ who meet nursing facility level of care but choose to remain in the community.
The Nurse Case Manager conducts in-home visits to assess functional and cognitive status, develops individualized care plans, and coordinates services to support participants’ needs and goals. This role also oversees the delivery of assistive home care services.
Schedule: varied
Work Location: On the road in assigned territory, including Danvers and surrounding areas throughout the north shore.
- Conduct scheduled and as-needed home visits to assess safety, compliance, and care needs
- Develop, implement, and evaluate individualized care plans
- Monitor participants’ health status and identify changes requiring intervention
- Ensure accurate, timely documentation in the electronic health record (EHR)
- Collaborate with physicians, therapists, social workers, and other team members to coordinate participant care
- Communicate participant status changes and recommendations to the care team
- Educate participants and caregivers on disease processes, medications, and self-care strategies
- Valid driver’s license is required.
- Active Massachusetts Registered Nurse (RN) license is required
- Previous nursing experience in a hospital, clinical, or home health care setting is preferred.
- Experience in specialty areas such as wound care, chronic disease management, or geriatric care preferred.
- Strong clinical assessment and critical thinking skills.
- Ability to work independently and manage patient care in an unstructured, home-based environment.
- Proficiency in using Electronic Health Records (EHR) and other health care documentation systems.
- Knowledge of home health care regulations, care protocols, and best practices.
- Excellent communication, interpersonal, and organizational skills.
- Competitive compensation
- Mileage reimbursement
- Retirement planning: 403(b) savings plan with employer match
- Tuition reimbursement
- Access to personal wellness and financial support programs
Since 1911, All Care has been expanding programs and services to meet the changing needs of the patients we serve. All Care’s dedicated health care professionals and caring staff provide the highest quality, compassionate services to patients and families throughout the North Shore, Eastern MA, Greater Boston & Merrimack Valley communities. All Care specializes in providing a full continuum of in-home services. From nursing and rehabilitation therapy to palliative and hospice care to private pay services and adult foster care, we offer solutions, resources, and assistance to each patient and family ensuring quality of life at every phase of need. All Care is Medicare certified and licensed by the Commonwealth of Massachusetts.