RN Case Manager – In-Home Assessments & Care Coordination

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

Job summary

Fallon Health seeks an Assessment Nurse Case Manager to perform in-home and telehealth assessments for new enrollees, completing HRAs, PCA assessments, and yearly MDS submissions. The role requires Massachusetts RN licensure and a strong ability to work with interdisciplinary teams.

The position emphasizes timely onboarding within 30 days of enrollment, coordination with care teams, and education of members on the NaviCare program. Driving is required.

Qualifications

• Graduate from an accredited school of nursing.
• Active, unrestricted RN license in Massachusetts.
• BSN or higher degree preferred; Case Management certification desirable.
• Must have or be willing to obtain Case Management certification.
• Must have reliable transportation and valid driver’s license.
• Experience with in-home assessments and telehealth preferred.
• Able to work on interdisciplinary teams and communicate effectively.

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.

Skills

Clinical RN experience

In-person assessments

Telehealth assessments

Interdisciplinary teamwork

Communication skills

Problem solving

Cultural sensitivity interviewing

Education

BSN or higher degree

Accredited nursing program

Tools

OASIS/MDS

Job description

Fallon Health seeks an Assessment Nurse Case Manager to perform in-home and telehealth assessments for new enrollees, completing HRAs, PCA assessments, and yearly MDS submissions. The role requires Massachusetts RN licensure and a strong ability to work with interdisciplinary teams.

The position emphasizes timely onboarding within 30 days of enrollment, coordination with care teams, and education of members on the NaviCare program. Driving is required.