Senior Care Options - Assessment Nurse Case Manager - Boston

Fallon Health • Boston, MA

2d • Hybrid

About The Position

The Senior Care Options Assessment Nurse Case Manager will be covering and visiting members in the Boston Region. Fallon Health is a company that cares, prioritizing members and ensuring they receive the care they need. Founded in 1977, Fallon Health delivers equitable, high-quality, coordinated care and is recognized nationally for member experience, service, and clinical quality. The company values diversity and inclusion, embracing individual differences. Fallon Health aims to be a leading provider of government-sponsored health insurance programs, including Medicare, Medicaid, and PACE. The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment for onboarding and regulatory assessments. They also complete in-person Health Risk Assessments (HRAs) according to assigned frequency, and all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool, as well as yearly PCA reevaluations. Additionally, the role is responsible for the timely and accurate submission of yearly MDS assessments and assessments when there is a significant change in status. Assessments are primarily done in person but may occasionally be completed telephonically.

Requirements

• Graduate from an accredited school of nursing mandatory.
• Active, unrestricted license as a Registered Nurse in Massachusetts.
• Must possess a valid drivers’ license.
• Must attest to no disqualifiers per Driver Safety Policy.
• Must possess and provide proof of minimal state required auto insurance.
• Must have reliable transportation.
• 1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
• Ability to conduct assessments in-person and telehealth.
• Ability to work on interdisciplinary teams.
• Skill in screening social determinants of health.
• Strong communication and interviewing skills.
• Problem-solving skills and adaptability.
• Knowledge or willingness to learn regulatory requirements.

Nice To Haves

• Bachelors (or advanced) degree in nursing or a health care related field preferred.
• Certification in Case Management strongly desired.
• Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions experience.
• Reliable home internet.

Responsibilities

• Conducts home visits for onboarding and regulatory assessments.
• Completes HRAs and PCA assessments.
• Submits MDS assessments.
• Provides education on NaviCare case management program.
• Conducts telephonic assessments when appropriate.
• Collaborates with Care Team.
• Completes LTSS evaluations and collaborates with UM.
• Conducts in-home assessments with motivational and culturally sensitive interviewing.
• Performs medication reconciliation.
• Completes State-required assessment tools per contract.
• Conducts functional assessments for LTSS programs.
• Participates in training and audits.
• Completes telephonic/virtual assessments.
• Maintains program/policy knowledge to educate members.
• Supports HEDIS, Medicare 5 Star, and other initiatives.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior