RN Case Manager — Care Coordination & Telehealth

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

Job summary

Fallon Health in Massachusetts is seeking an experienced RN Case Manager to join an interdisciplinary care team focused on care coordination and improving access and quality for NaviCare members. You will establish relationships with members and caregivers, conduct assessments, and develop care plans in alignment with benefits and community resources.

Responsibilities include conducting transition of care assessments, medication reconciliations, and collaborating with Navigators, PCPs,

Qualifications

• 1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
• Ability to conduct assessments in-person and via telehealth.
• Ability to work on interdisciplinary teams.
• Skill in screening social determinants of health.
• Strong communication and interviewing skills.
• Knowledge or willingness to learn regulatory requirements.
• Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.
• Reliable transportation and driving your personal vehicle is an essential job function.

Responsibilities

• Assess and manage a member panel through in-person and telephonic outreach.
• Complete medication reconciliations and care transition assessments.
• Educate members on benefits, rights, disease management, medications, and preventive screenings, ensuring participation in care plans.
• Support member self-management through coaching and health education.
• Develop and update individualized care plans based on assessments.
• Coordinate services and authorize care according to program and regulatory standards.
• Collaborate with Navigators, PCPs, Behavioral Health Case Managers, pharmacists, and community partners.
• Track progress toward goals and adjust care plans as needed.
• Participate in interdisciplinary rounds and team communication.
• Build relationships with members, caregivers, and providers for coordinated, culturally appropriate care.
• Complete assessments, screenings, notes, and care plans within regulatory timelines.
• Follow HIPAA and organizational confidentiality policies.
• Support HEDIS, Medicare 5-Star, and quality initiatives through outreach and education.
• Assist with departmental campaigns, projects, and coverage as assigned.

Skills

RN Experience

Care Coordination

Assessment Skills

Telehealth

Interdisciplinary Teamwork

Social Determinants

Regulatory Knowledge

Communication Skills

Driver's License

Education

RN License MA

Case Management Certification desired

Job description

Fallon Health in Massachusetts is seeking an experienced RN Case Manager to join an interdisciplinary care team focused on care coordination and improving access and quality for NaviCare members. You will establish relationships with members and caregivers, conduct assessments, and develop care plans in alignment with benefits and community resources.

Responsibilities include conducting transition of care assessments, medication reconciliations, and collaborating with Navigators, PCPs,