Nurse Case Manager: Health Home



Concerted Care Group, LLC is looking for an innovative, committed and highly skilled Nurse Case Manager to grow our integrated health organization. As part of CCG’s commitment to support our employee’s success, in addition to our comprehensive benefits package, we also offer private parking, company provided PPE, private office space, flexible and remote work options at our clean and modern clinics.

Concerted Care Group, LLC offers the most effective treatment of addiction available – including addiction to heroin, morphine, codeine, oxycodone, prescription painkillers, and other opiates. We’ve been around for 5 years and we are just getting started. Our outpatient clinic is conveniently located in the communities that we serve.

We treat the whole person, in the whole spectrum of their life.

CCG is looking for a dynamic Registered Nurse who coordinates care between patients in an opiate treatment program and the rest of their providers, including mental health, somatic care, dental, and social services. This position is primarily centered around data management and requires someone with a high degree of comfort managing record keeping and reporting. The health home model (not home health!) is a model that recognizes certain high risk populations can benefit from preventative care to improve overall outcomes. More information about the model can be found here

Under general supervision the Health Home Nurse Care Manager oversees the implementation of the CCG Health Home. This position is accountable for ensuring the continuity of care between the OTP program and somatic and behavioral healthcare providers both within CCG and in the community, as well as developing processes to assist consumers in the development and maintenance of healthy lifestyles and illness management skills.

Principle Responsibilities and Tasks

Provides services to patients in an outpatient behavioral health setting.

  • Acts as a comprehensive care coordinator for participants assigned to care, assessing their needs accordingly and facilitating communication amongst other clinicians providing care
  • Performs comprehensive assessments of physical, emotional, psychosocial and environmental needs of participants
  • Facilitates health education groups
  • Participates in care plan development
  • Assesses, coordinates and implements service planning needs of patients
  • Reviews results of laboratory tests and other diagnostic procedures and reports to the nurse practitioner or psychiatrist.
  • Identifies significant clinical findings, makes conclusions and intervenes appropriately under the direction of the nurse practitioner consultant.
  • Compares ongoing outcome data to baseline data to monitor clients.
  • Initiates client education based on identified learning needs of the client and/or those providing care and documents appropriately
  • Supports and monitors compliance of the individual including checking of prescription labels and storage.
  • Consults with behavioral health staff about participants’ identified health conditions
  • Attends treatment team meetings with behavioral health staff to plan and coordinate care
  • Assists in contacting medical providers & hospitals for coordination of care efforts
  • Provides training on medical diseases, treatments, & medications to health home participants.
  • Coordinates care and encourages staff participation in the service model
  • Assists in the training and education of OTP staff regarding programmatic services.
  • Provides training on medical diseases, treatments, & medications to behavioral health staff, as indicated.
  • Maintains Excel spreadsheets to track and report on patient outcomes.
  • Utilizes CRISP and eMedicaid public databases for information review and data entry.


Qualifications and Requirements

  • Licensure as a Registered Nurse in the state of Maryland in good standing
  • Technically proficient in Microsoft Office programs including Excel.
  • Demonstrated success in teaching, coaching, and development skills.
  • Ability to create a motivating environment for clinical and professional personnel. Collaborative.
  • Highly effective interpersonal, verbal, and written communication and presentation skills.
  • Demonstrate effectiveness as a group leader and participant.
  • Ability to independently develop and manage programs and projects.
  • Knowledge of the Maryland healthcare industry, preferred.
  • Ability to analyze and conceptualize data to ensure achievement of desired outcomes.
  • Ability to learn and use an electronic medical record and health information exchange to enter clinical information and run reports.
  • Takes action to correct observed risks to patient safety.
  • Reports adverse events and near misses to supervisor.
  • Develops effective working relationships and maintains good communication with other team members. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge


Concerted Care Group Baltimore, LLC is committed to Equal Employment Opportunity (EEO) and is committed to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran’s status or any other classification protected by State/Federal laws. Concerted Care Group, LLC offers competitive salaries and professional, rewarding work environment.