RN Case Manager - Medicare & Community Care

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

Job summary

Fallon Health in Massachusetts is seeking a Medicare/Community Care Nurse Case Manager to join our interdisciplinary team in Worcester. The NCM will perform telephonic assessments, develop coordinated care plans, and advocate for members to ensure timely access to benefits and services.

The role emphasizes care coordination, reducing readmissions, and aligning with NCQA/HEDIS standards while supporting members’ social determinants of health and transitions from hospital to home.

Qualifications

• Graduate from an accredited school of nursing; BSN or higher preferred.
• Active MA RN license; case management certification strongly desired.
• 1+ year of clinical experience with chronically ill patients; telephonic interviews required.

Responsibilities

• Assess and manage a member panel via telephonic contact.
• Coordinate care plans, educate and advocate for members.
• Monitor NCQA metrics and HEDIS performance; support transitions from ER/inpatient to home.

Skills

Communication

Care coordination

Telephonic interviewing

Education

Bachelor's degree in Nursing

Job description

Fallon Health in Massachusetts is seeking a Medicare/Community Care Nurse Case Manager to join our interdisciplinary team in Worcester. The NCM will perform telephonic assessments, develop coordinated care plans, and advocate for members to ensure timely access to benefits and services.

The role emphasizes care coordination, reducing readmissions, and aligning with NCQA/HEDIS standards while supporting members’ social determinants of health and transitions from hospital to home.