Nurse Case Manager - Assessment for SCO program - Fall River/New Bedfored

Fallon Community Health Plan, Inc.; New Bedford (MA); On-site; USD 95,000 - 100,000; Full time

Job summary

Fallon Health in Massachusetts seeks an Assessment Nurse Case Manager to perform in-home onboarding visits and regulatory assessments for new enrollees, with in-person HRAs and PCA evaluations. Roles include annual MDS submissions and telehealth assessments as appropriate.

The position requires an active MA RN license, a nursing degree (BSN preferred), and case management certification is strongly desired. Driving is required with reliable transportation.

Qualifications

• Graduate from an accredited school of nursing mandatory.
• Active, unrestricted license as a Registered Nurse in Massachusetts.
• Certification in Case Management strongly desired.
• Driving your personal vehicle is an essential job function with valid license and insurance.

Responsibilities

• Conducts home visits for onboarding and regulatory assessments.
• Completes HRAs and PCA assessments.
• Submits MDS assessments.
• Provides education on NaviCare case management program.
• Conducts telephonic assessments when appropriate.
• Collaborates with Care Team.
• Completes LTSS evaluations and collaborates with UM.
• Performs medication reconciliation.
• Maintains program/policy knowledge to educate members.

Skills

Communication skills

Interdisciplinary teamwork

Assessment skills

Motivational interviewing

SDOH screening

Problem solving

Education

Bachelor's degree in nursing

Massachusetts RN license

Case management certification preferred

Job description

Overview

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and completes regulatory assessments. The Assessment Nurse Case Manager completes in person Health Risk Assessments (HRAs) in accordance with members assigned frequency. The Assessment Nurse Case Manager completes all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool and well as yearly PCA reevaluations. The Assessment Nurse Case Manager is also responsible for the timely and accurate submission of yearly (and when there is a significant change in status) MDS assessments. Assessments are done primarily in person but may at times be completed telephonically.

Responsibilities

Overview

• Conducts home visits for onboarding and regulatory assessments.

• Completes HRAs and PCA assessments.

• Submits MDS assessments.

• Provides education on NaviCare case management program.

• Conducts telephonic assessments when appropriate.

• Collaborates with Care Team.

• Completes LTSS evaluations and collaborates with UM.

Member Assessment, Education & Advocacy

• Conducts in-home assessments with motivational and culturally sensitive interviewing.

• Performs medication reconciliation.

• Completes State-required assessment tools per contract.

• Conducts functional assessments for LTSS programs.

• Participates in training and audits.

• Completes telephonic/virtual assessments.

• Maintains program/policy knowledge to educate members.

• Supports HEDIS, Medicare 5 Star, and other initiatives.

Qualifications

Education:

Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred.

License :

Active, unrestricted license as a Registered Nurse in Massachusetts

Certification :

Certification in Case Management strongly desired

Other : Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

• Must possess a valid drivers’ license

• Must attest to no disqualifiers per Driver Safety Policy

• Must possess and provide proof of minimal state required auto insurance

• Must have reliable transportation

Experience:

• 1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.

• Ability to conduct assessments in-person and telehealth.

• Ability to work on interdisciplinary teams.

• Skill in screening social determinants of health.

• Strong communication and interviewing skills.

• Problem-solving skills and adaptability.

• Knowledge or willingness to learn regulatory requirements.

• Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.

• Reliable home internet.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Location US-MA-New Bedford