Fallon Health Clinical Integration Nurse Training Specialist in Worcester, Massachusetts

Overview

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary of Purpose :

  • Collaborates with business owners and subject matter experts to develop trainings and deliver content; coordinates the Nurse Case Manager new hire’s training experience for the first six months of employment in conjunction with the Clinical Integration Training Specialist; works with Leaders to ensure the new hire is proficient in job role; coordinates new hire training schedules and ensure the new hires are proficient; and as required, works to implement additional teachings and experiences for the new hire as indicated to ensure new hire competency success

  • Audits Nurse Case Manager documentation and ensures compliance to established competency standards and regulatory needs, working in conjunction with staff and Department Leaders to improve team member performance

  • Develops and leads training/educational programs/modules intended to enhance the knowledge and efficiency of all Clinical Integration Nurse Case Managers ongoing in conjunction with the team leadership

  • Obtains feedback from Clinical Integration Leaders and staff on processes and staff understanding of such and develops training programs/strategies to ensure team member success in conjunction with the Training Specialist and Department Leaders

  • May carry a caseload of members and perform case management/care coordination services for such according to Nurse Case Manager job description requirements

Responsibilities

5+ years job experience as a Registered Nurse working in a case management/care coordination role in a managed care payor required.

Experience with NCQA, CMS, and other required regulatory requirements and experience writing and developing policies and process documents required.

Experience training others and demonstrated knowledge of individual learning styles and ability to customize teaching methods to ensure learner success required.

Experience with developing audit tools, auditing team member performance, and working with staff to improve their performance preferred.

Demonstrated proficiency including but not limited to:

  • Ability to develop a system and process to objectively measure care management competencies and to hold team members accountable, including, but not limited to developing corrective action plans, as appropriate

  • Ability to identify gaps in staff’s knowledge base and to design training materials to address those gaps

  • Ability to teach others in an organized and structured manner utilizing adult learning principles and collaboration skills

  • Exceptional interpersonal skills and willingness to continually modify training modules working in conjunction with subject matter experts to ensure training content is accurate

  • Ability to recognize when training techniques are not effective and ability to adapt teaching style to meet learner’s needs

  • Ability to train on technical and non-technical business requirements, processes and service orientated responsibilities

  • Software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word

  • Manipulation of Excel spreadsheets to manage work and exposure and familiarity with pivot tables desirable

  • Physician and other health care provider interaction and other communication including but not limited to face to face communication with physicians and health care providers

  • Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education

  • Exceptional customer service skills and willingness to assist ensuring timely resolution

  • Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties

  • Knowledgeable about community resources available to assist populations and staff with managing populations in the community and long term care settings and demonstrated willingness to seek resources and expand knowledge to assist the population

  • Knowledgeable about medical record documentation

  • Critical thinking skills for independent problem solving

  • Collaborates with business owners and subject matter experts to develop trainings and deliver content; coordinates the Nurse Case Manager new hire’s training experience for the first six months of employment in conjunction with the Clinical Integration Training Specialist; works with Leaders to ensure the new hire is proficient in job role; coordinates new hire training schedules and ensure the new hires are proficient; and as required, works to implement additional teachings and experiences for the new hire as indicated to ensure new hire competency success

  • Audits Nurse Case Manager documentation and ensures compliance to established competency standards and regulatory needs, working in conjunction with staff and Department Leaders to improve team member performance

  • Develops and leads training/educational programs/modules intended to enhance the knowledge and efficiency of all Clinical Integration Nurse Case Managers ongoing in conjunction with the team leadership

  • Obtains feedback from Clinical Integration Leaders and staff on processes and staff understanding of such and develops training programs/strategies to ensure team member success in conjunction with the Training Specialist and Department Leaders

  • May carry a caseload of members and perform case management/care coordination services for such according to Nurse Case Manager job description requirements

Onboarding New Clinical Integration Nurse Case Manager Team Employees

  • Conducts seminars, workshops and individual training sessions both in person and virtually

  • Conducts monthly Orientation in conjunction with Clinical Integration Training Specialist

  • Collaborates with other business areas of Fallon Health to schedule guest speakers for Orientation from the clinical aspect in conjunction with the Clinical Integration Training Specialist

  • Mentors and support new Nurse Case Manager employees during first 3-6 months of hire as additional point of contact

  • Provides follow-up to orientation after 6 months to ensure nurse case manager employees are meeting performance standards

  • Communicates effectively with employees by phone, in person, or through electronic correspondence.

Ongoing Departmental Trainings – Nurse Case Manager job role focus

  • Collaborates with leaders to determine training needs and schedule training sessions

  • Conducts seminars, workshops, individual training sessions both in person and virtually

  • Identifies areas where workflows are lacking or outdated and provide suggestions for improvement

  • Maintains knowledge of instructional technologies by attending workshops; reviewing professional publications; establishing personal networks; participating in professional societies

  • Proactively researches training content with Subject Matter Experts through interview techniques, review of existing documentation and job shadowing.

  • Communicates effectively with employees by phone, in person, or through electronic correspondence.

  • Collaborate with the Medical Management Program Manager on identifying Clinical Integration team CEU needs and implementing an in-house CEU program

Audit Function

  • Audits Nurse Case Manager documentation, completing objective audit tools ensuring team member compliance with regulatory and accreditation requirements

  • Audits Nurse Case Manager documentation ensuring documentation meets quality standards and interventions and actions are effective to meet member needs

  • Delivers audit result feedback to Nurse Case Managers and their leader and works in conjunction with the leader to implement leader developed team member corrective action plans when warranted

Nurse Case Manager Job Functions

  • Performs case management/care coordination services for a member panel based upon department need

Administrative Duties

  • Prepares training educational material such as presentations, handouts, best practices

  • Designs, develops, and updates effective training programs

  • Proofreads, edits, and maintains class materials and documentation to improve quality, readability, consistency, and effectiveness

  • Works in collaboration with the Clinical Integration Training Specialist to develop and implement a cohesive, effective training program for the entire team

  • Creates and conducts evaluations to identify areas of improvement

  • Keeps attendance and other records as required

  • Maintains up to date knowledge of Fallon Health products and benefits, product specific Evidence of Coverage details, and department policies and processes

  • Provides education about product benefits and Evidence of Coverage content, processes, and member rights and responsibilities

  • Updates resource library to ensure all staff have access to the most up to date documents

Qualifications

Education : Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field required.

License: Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver’s license and a vehicle to be used to transport self to meetings with Clinical Integration Staff located throughout the service area

Certification : Certification in Case Management preferred

Resources : Microsoft Office products including but not limited to: Excel, PowerPoint, Word, Outlook, Visio, Business Objects, QNXT, TruCare, and other applications

Other: Satisfactory Criminal Offender Record Information (CORI) results.

Job ID 5533

# Positions 1

Category Nursing

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