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Fallon Health RN Care Manager Growing MLTC Plan in Amherst, NY, New York


About Fallon Health :

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 delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. 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. Learn more at fallonhealth.org or follow us on Facebook, Twitter, and LinkedIn.

Fallon Health Weinberg-MLTC:

Fallon Health Weinberg-MLTCis a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg a Managed Long Term Care (MLTC) is a plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high quality, affordable health care.


  • Reviews Member enrollment data, claims data, urgent and emergency room utilization, acute/skilled nursing inpatient census, referrals from Interdisciplinary Care Team (ICT) and vendors, and other appropriate data prior to initiating any Member contact

  • Contacts Members/caregivers telephonically and/or in person to at time of enrollment, at time of care transition, and/or ongoing based upon Program requirements to:

  • Perform a health needs assessment

  • Assess the health needs of the Members and/or

  • Recommend modifications to care plan elements

  • Completes a home visit/facility visit for all assigned Members as necessary, ideally within the first 60 days of members enrollment, any time there is a clinical change, or at intervals defined by FHW in order to determine member’s current needs.

  • Is a member of the assigned members ICT and attends all meetings.

  • Works closely with the Member’s team to initiate ICT meetings with ICT members/Members/caregivers as necessary and ensures the participation of appropriate interdisciplinary team members

  • As a member of the ICT, updates all relevant team members regarding the Member’s status and develops/proposes changes to the care plan

  • Identifies, aligns, and utilizes health plan and community resources that impact high-risk/high cost care

  • Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the Member attains pre-determined outcomes

  • Streamlines the focus of the Member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care

  • Works collaboratively and cohesively with all members of the Primary Care

  • Utilizes a successful communication style and methods to engage Member’s in care management – does not ‘easily give up’ and works to engage Member’s as appropriate

  • Identifies and shares best practices and innovative care management strategies with the team

  • Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/Designee

  • Strictly observes HIPPA regulations and the FHW policies regarding confidentiality of member information

  • Performs other responsibilities as assigned by the Supervisor/designee

  • Other tasks as identified


Education: Graduate from an accredited school of nursing or Master’s Degree in social work required

License: Active, unrestricted license as a Registered Nurse in New York state

Certification: Certification in Case Management desired, encouraged upon hire


  • A minimum of three to five years clinical experience as a Registered Nurse or social worker working with the chronically ill, geriatric patients.

  • Minimum 2 years of experience in Home Health care setting working with Medicare/Medicaid required having demonstrated care coordination, accessing community resources a plus.

  • Experience working with patients/members in Long term care setting a plus.

  • Experience as a care manager within a payer setting with demonstrated ability to case manage a plus.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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.

Location US-NY-Amherst, NY

Posted Date 3 months ago (6/16/2022 3:19 PM)

Job ID 6905

# Positions 1

Category Case Management