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Fallon Health Senior Care Options Nurse Case Manager - Worcester County in Worcester, Massachusetts

Overview

Several NEW SCO RN NCM positions in multiple geographies! This Senior Care Options Nurse Case Manager position will cover Worcester, MA.

We are GROWING! Are you looking for that next level in your career where instead of providing direct patient care, you touch upon all aspects of healthcare delivery? Are you ready for a flexible and safe nursing job with leaders who encourage work-life balance? Would you enjoy a Monday-Friday daytime job with paid holidays off, no nights, weekends, or on-call? Are you a team-player who understands the fluidity of healthcare? Would you enjoy helping the elderly Navigate the healthcare system and implement services to stay safe in their homes for as long as possible? Would you like to work from your home and have the flexibility to schedule your own home visits? If so, this may be the job for you!

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.

About NaviCare :

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.

Brief Summary of Purpose:

The Nurse Case Manager (NCM)is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. NCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the NCM and Care Team. Responsibilities may include conducting in home face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The NCM may conduct assessments and may determine the number of hours’ members require for MassHealth programs such as the personal care attendant program, adult foster care, group adult foster care, and other programs per product benefits and guidelines. The NCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction.

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 a variety of interviewing techniques

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

Qualifications

Education:

Graduate from an accredited school of nursing mandatory

License/Certifications:

  • License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits

  • Other: 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

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.

Keywords: remote, flexible, work from home, RN, NCM, telephonic, insurance, nurse case manager, SCO, senior care options, Registered Nurse

Location US-MA-Worcester

Posted Date 2 months ago (12/19/2022 5:03 PM)

Job ID 7132

# Positions 1

Category Nursing

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