Fallon Health Senior Care Nurse Case Manager in Quincy, Massachusetts
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.
This Senior Care Case Manager position is Mostly Working from Home + Requires in Home Visits covering Middlesex County and Eastern MA. Spanish or Khmer speaker preferred.
Do you like to help senior (65+) patients/members but don’t want to be on the front lines? Do you have the organization, communication, and collaboration skills needed to help Care Manage our Navicare Fallon Health members to access, receive and coordinate their care? If yes, this remote role is for you!
This Nurse Case Manager role is pivotal in case managing the care of our complex Navicare (age 65+) members. Duties include but are not limited to: telephonically assessing and case managing a member panel, conducting in home face to face visits for onboarding new enrollees and reassessing members annually, performing medication reconciliations, serving as an advocate for members to ensure they receive Fallon Health benefits as appropriate, educating members on preventative screenings and other health care procedures such as vaccines, and screenings, and ensuring members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team.
Do you have strong working knowledge of Nursing Care Plans, disease management and community resources? As well as proficiencies using Microsoft products including excel pivot tables? Are you organized and want to help patients without being on the front lines?
If yes, apply now and learn more about this role and our dynamic team!
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 a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a Member’s clinical/functional status to identify ongoing special conditions and develops and implements an individualized, coordinated care plan, in collaboration with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome
Performs medication reconciliations
Performs Care Transitions Assessments – per Program and product line processes
Utilizing clinical judgment and nursing assessment skills, may complete NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when a member’s medical/functional status changes that warrants a change in rating category to ensure members are in the correct State defined rating category
Care Coordination and Collaboration
Provides culturally appropriate care coordination, i.e. works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers, and/or authorized representatives
With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs while completing program assessments and working with the Navigator to ensure the member approves their care plan
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
Performs other responsibilities as assigned by the Manager/designee
Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee
Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred.
License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits
Certification : Certification in Case Management strongly desired
Other: Satisfactory Criminal Offender Record Information (CORI) results
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
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.
Posted Date 2 weeks ago (1/7/2022 1:45 PM)
Job ID 6684
# Positions 1