Senior RN Triage & Case Manager - IHCS/PCA Expert

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

Job summary

Fallon Health is seeking a Case Manager Triage Nurse hybrid role in Massachusetts to serve as the clinical subject matter expert and operational lead for IHCS and PCA programs. You will provide clinical triage, case consultation, and interdisciplinary collaboration to resolve complex member issues while ensuring compliance with state and organizational requirements.

The role combines nurse case management, triage, and program leadership to create single-point ownership for IHCS and PCA matters,

Qualifications

• Licensed RN in Massachusetts.
• Certification in Case Management strongly desired, willingness to obtain.
• Must possess valid driver’s license and reliable transportation.
• Experience with home health, Medicare/Medicaid, and regulatory requirements is preferred.

Responsibilities

• Serve as primary clinical liaison for IHCS.
• Lead triage and case consultations for complex member needs.
• Coordinate communication among IHCS providers and leadership.
• Monitor performance metrics and ensure regulatory compliance.
• Lead efforts to standardize PCA-related processes.

Skills

Clinical RN experience

Interdisciplinary teamwork

Communication skills

Regulatory knowledge

Education

RN degree

Tools

OASIS/MDS

Job description

Fallon Health is seeking a Case Manager Triage Nurse hybrid role in Massachusetts to serve as the clinical subject matter expert and operational lead for IHCS and PCA programs. You will provide clinical triage, case consultation, and interdisciplinary collaboration to resolve complex member issues while ensuring compliance with state and organizational requirements.

The role combines nurse case management, triage, and program leadership to create single-point ownership for IHCS and PCA matters,