Resident Care Nurse at Bethany Community Services Inc – Haverhill, Massachusetts

General Summary

The Resident Care Nurse (RCN) is a licensed nurse (RN or LPN) responsible for providing direct clinical oversight, assessments, and care coordination for residents receiving services through the Resident Care Department across Assisted Living (33 traditional units) and Independent Living settings.

The RCN supports the delivery of high quality, resident-centered care in accordance with Bethany’s service standards and applicable Massachusetts Executive Office of Aging & Independence (AGE), 651 CMR 12.00 regulations.

This role focuses on resident assessments, care planning, case management, and coordination of services while providing guidance and clinical support to Resident Care Aides (RCAs). The RCN collaborates closely with the Resident Care Director and interdisciplinary team to ensure safe, effective, and well-coordinated care that supports aging in place.

Essential Job Functions:

Assisted Living Responsibilities

• Conduct initial and ongoing resident assessments in compliance with 651 CMR 12.00 (AGE) regulations.

• Develop, implement, and update individualized service plans based on assessed needs, physician input, and resident preferences.

• Perform routine reassessments and adjust care plans in response to changes in resident condition.

• Monitor resident health status, response to services, and overall well-being.

• Ensure services provided by RCAs align with established service plans.

• Provide clinical guidance and direction to Resident Care Aides (RCAs) to support quality care delivery.

• Document all assessments, service plans, progress notes, and incidents accurately in the Electronic Health Record (EHR).

• Educate residents and families on care plans, available services, and expectations within scope of licensure.

• Coordinate care with physicians, families, and external providers (e.g., home health, hospice, rehab) to support continuity of care.

• Respond to changes in condition, incidents, and urgent resident needs, communicating appropriately with the care team and Resident Care Director.

• Support resident transitions, including move-ins, changes in level of care, and external transfers.

• Participate in on-call rotation to provide clinical support and guidance to staff as needed.

Independent Living Responsibilities

• Conduct service assessments for Independent Living residents enrolled in supportive service programs (e.g., personal care, housekeeping, laundry, medication reminders).

• Develop and update service plans based on resident needs, preferences, and safety considerations.

• Monitor service delivery to ensure quality, consistency, and alignment with established plans.

• Provide case management and coordinate services with internal staff and external providers as needed.

• Serve as a resource to residents regarding health, wellness, and available services, including those not currently enrolled in programs.

• Encourage appropriate service utilization to support resident safety and independence.

• Communicate with residents and families regarding service changes, concerns, or needs.

• Document all services, care coordination, and updates in the EHR system.

Care Coordination & Team Collaboration (All Settings)

• Collaborate with the Resident Care Director regarding care plans, changes in condition, and service needs.

• Communicate effectively with RCAs, Resident Service Coordinators (RSCs), and other departments (Dining, Maintenance, Property Management) to ensure coordinated care.

• Coordinate care with families, healthcare providers, insurance plans, and community agencies.

• Monitor external services to ensure continuity and appropriateness of care.

OTHER DUTIES AND RESPONSIBILITIES

• Attend training and professional development courses and sessions to remain current with the industry, health care programs, and initiatives.

• Other duties as assigned may be required to meet the operational needs of the Resident Care Department.

Prefered Competencies- Willing to train the right person!

· Knowledge of Federal and State programs (Medicare, Medicaid, MassHealth, Group Adult Foster Care, Senior Care Options (SCO’s), Home and Community Based Waiver Program, Massachusetts State Home Care Program, PACE program)

· Experience with homecare of community-based software (or web-based) systems is required.

· Knowledge of and experience with Electronic Health Records (EHR’s) is highly desired.

· Organizational skills, interpersonal skills, excellent verbal, and written communication skills

· Experience and ability to work with an elderly population.

· Intermediate to advanced computer skills are required. Experience with Word, Excel and the internet is required.

· Long periods of standing may be required. Agility and the ability to push, pull and bend are required. Ability to lift up to 50 pounds unassisted.

· Ability to read, write and communicate in English is required.

· Transportation availability and ability to travel between locations is required.

PREPARATION, KNOWLEDGE, SKILLS & ABILITIES

• Current RN or LPN license in Massachusetts required.

• A valid and current driver’s license is required.

• Experience with an elderly population, the aging process, elder services, disability services, eligibility for and procedures of Federal and applicable State entitlement programs

• Demonstrated working knowledge of supportive services and other resources for senior citizens and non-elderly disabled.

• Demonstrated ability to advocate, organize, problem solve and provide results for the elderly and non-elderly disabled.