Spoke RN Care Coordinator

Registered Nurse St. Albans, VT


Spoke  RN Care Coordinator

** Sign on bonus offered for eligible applicants and offered for a limited time.** 

**Details to be discussed during the interview process.**

BAART is looking for an adaptable and effective Registered Nurse (RN) to coordinate care of patients receiving Medication Assisted Therapy (MAT) for opioid addiction.  The RN Care Coordinator will be a part Vermont’s Hub and Spoke care team, responsible for providing specialized nursing and care management to support patients in recovery.  An ideal candidate assures team-based care and helps primary care providers balance MAT patient care with the needs of their full patient panel.

Essential Duties & Responsibilities:

  • Health Home Services / Activities: Team with a Clinical Care Coordinator, to provide health home services to a panel of 100 MAT patients (per Full-Time Equivalent of care coordination).
  • Comprehensive Care Management: Activities undertaken to identify patients for Medication Assisted Therapy, conduct initial assessments, and formulate individual plans of care. 
  • Care Coordination: Implementation of individual plans of care (with active patient involvement) through appropriate linkages, referrals, coordination and follow-up as needed to services and supports across treatment and human services settings and providers.
  • Health Promotion: Activities that promote patient activation and empowerment for shared decision making in treatment, healthy behaviors, and self-management of health, mental health, and substance abuse conditions.
  • Comprehensive Transitional Care: Care coordination focused on planned, seamless transitions of care through streamlining the movement of patients from one treatment setting to another, between levels of care, and between health and specialty MH/SA service providers.
  • Individual and Family Support: Assisting individuals to fully participate in treatment, reducing barriers to access to care, supporting age and gender appropriate adult role functioning, and promoting recovery.
  • Referral to Community & Social Support Services: Assisting clients obtain and maintain eligibility for formal supports and entitlements (e.g., health care, income support, housing, legal services) and to participate in informal resources to promote community participation and well-being.
  • Health Home Quality Measures: In collaboration with the Care team, tracking and reporting Health Home Quality Measures.
  • Maintains safe work practices, confidentiality, professional demeanor and appearance.
  • Other duties, as assigned


  • Graduate of accredited school of nursing with valid Vermont State Registered Nurse License required.
  • Five years of clinical nursing experience required.
  • Experience in mental health settings or substance treatment program highly preferred, experience in a physician practice or case management highly preferred.
  • Case management certification preferred. 
  • Ability to establish a therapeutic relationship with patients and support resources (family or friends).
  • Strong organizational skills with ability to manage numerous cases effectively.
  • Skilled at process and clinical outcomes improvement using quality improvement methodologies, including tracking and reporting measures.
  • Ability to effectively use Microsoft Office suite of products, Web-based applications for assessing and managing addiction, multiple physician electronic medical records, patient registries, and BAART Programs information system, Methasoft.
  • Reliable transportation, valid driver’s license and automobile insurance required.
  • Satisfactory drug screen and criminal background check. 



  • Competitive salary
  • Comprehensive benefits package including medical, dental, vision and 401(K)
  • Generous paid time off accrual
  • Excellent growth and development opportunities
  • Satisfying and rewarding work striving to overcome the opioid epidemic


Here is what you can expect from us:

BAART a progressive substance abuse treatment organization is committed to the highest quality of patient care in partnership with Blueprint for Health.  The Vermont Blueprint for Health designs community-led strategies for improving health and well-being.  Hub and Spoke program is Vermont’s system of Medication Assisted Treatment, supporting people in recovery from opioid use disorder.  Our ultimate goal is to address the physical, emotional, and mental aspects of opioid use disorder to help each of our patients achieve long-term recovery and an improved quality of life.  

BAART is committed to Equal Employment Opportunity (EEO) and 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.