SCO Assessment Nurse Case Manager - Lawrence/Lowell

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

Job summary

Fallon Health is seeking an Assessment Nurse Case Manager to conduct in-home assessments and health risk evaluations. This role requires an active RN license in Massachusetts and involves collaborating with care teams to ensure members receive appropriate support and education.

The successful candidate will have at least one year of clinical experience and strong communication and problem-solving skills. The position offers a pay range of $95,000 - $100,000 per year.

Qualifications

• Active, unrestricted Registered Nurse license in Massachusetts.
• Willingness to obtain Case Management certification.
• Must have reliable home internet.

Responsibilities

• Conducts home visits for assessments.
• Completes HRAs and PCA assessments.
• Submits MDS assessments.
• Educates members on case management programs.
• Conducts telephonic assessments when required.
• Collaborates with Care Team.

Skills

Clinical RN experience

Assessments in-person and telehealth

Interdisciplinary teamwork

Knowledge of regulatory requirements

Strong communication skills

Problem-solving skills

Education

Associate's degree in nursing

Bachelor's degree in nursing

Job description

Location: US-MA-Lawrence

Job ID: 8407 | # Positions: 1 | Category: Nursing

Overview

About us: 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.

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

Qualification requirements

Education: RN's: Graduate from an accredited school of nursing, associate’s degree required, bachelor’s or higher preferred.

License/Certifications: License: RN Candidates (Required) Active, unrestricted license as a Registered Nurse in Massachusetts. Certification: Certification in Case Management strongly desired, willingness to obtain when eligible.

Other: Driving your personal motor vehicle is an essential job function of this position and the following requirements apply: Must possess a valid driver's 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.