Nurse Case Manager Boston

5 days ago

Worcester, Massachusetts, United States Fallon Health Full time
About Fallon Health

Fallon Health is a company that prioritizes its members' needs, ensuring they receive the care they deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are 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.

Job Summary

The Nurse Case Manager (NCM) is an integral part of an interdisciplinary team focused on care coordination, care management, and improving access to and quality of care for Fallon members. The NCM seeks to establish telephonic and/or face-to-face relationships with the member/caregiver(s) to ensure ongoing service provision and care coordination, consistent with the member-specific care plan developed by the NCM and Care Team.

Responsibilities
  • Member Assessment, Education, and Advocacy
    • Telephonically assesses and case manages a member panel
    • May conduct in-home face-to-face visits for onboarding new enrollees and reassessing members, utilizing various interviewing techniques
  • Provider Partnerships and Collaboration
    • May attend in-person care plan meetings with providers and office staff and may lead care plan review with providers and care team as applicable
    • Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met
  • Regulatory Requirements - Actions and Oversight
    • Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to product regulatory requirements and Program policies and processes
    • Knowledge of and compliance with HEDIS and Medicare 5-Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams
Qualifications
  • Education: Graduate from an accredited school of nursing mandatory; Bachelors (or advanced) degree in nursing or a healthcare-related field preferred
  • License/Certifications: Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable transportation; Certification in Case Management strongly desired; Satisfactory Criminal Offender Record Information (CORI) results
  • Experience: 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required; Understanding of Hospitalization experiences and the impacts and needs after facility discharge required; Experience working face-to-face with members and providers preferred; Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking, required; Home Health Care experience preferred

COVID-19 Vaccination: Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations, and policies are required to be vaccinated and/or they are in Member/participant-facing positions.

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.

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