Assessment Nurse Case Manager

Fallon Health•Worcester, MA

4d•$95,000 - $100,000

About The Position

The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to support onboarding and complete regulatory assessments. The position conducts in-person Health Risk Assessments (HRAs) at the frequency assigned to members, completes new Personal Care Attendant (PCA) assessments using the integrated time-for-task tool and yearly PCA reevaluations, and submits yearly MDS assessments and assessments required following a significant change in status. Assessments are primarily completed in person, but may sometimes be conducted by phone or virtually. The role provides education about the NaviCare case management program, completes LTSS evaluations in collaboration with Utilization Management, and works with the Care Team. The nurse conducts motivational, culturally sensitive interviews; reconciles medications; completes state-required assessment tools; and supports quality initiatives including HEDIS and Medicare 5 Star. The position also participates in training and audits and maintains knowledge of program policies and regulatory requirements. Fallon Health is a Worcester, Massachusetts-based health plan founded in 1977. Its mission is to improve health and inspire hope, with a focus on government-sponsored health insurance programs including Medicare, Medicaid, and PACE. The organization describes its commitment to equitable, high-quality coordinated care and an inclusive workplace.

Requirements

Graduate from an accredited school of nursing.
Hold an active, unrestricted Registered Nurse license in Massachusetts.
Have at least 1 year of clinical RN experience with complex medical, behavioral, and social co-morbidities.
Be able to conduct in-person and telehealth assessments.
Be able to work on interdisciplinary teams.
Have skill in screening social determinants of health.
Have strong communication and interviewing skills.
Have problem-solving skills and adaptability.
Have knowledge of regulatory requirements or willingness to learn them.
Possess a valid driver’s license.
Attest to having no disqualifiers under the Driver Safety Policy.
Possess and provide proof of at least the state-required auto insurance.
Have reliable transportation.

Nice To Haves

Bachelor’s degree or advanced degree in nursing or a health care-related field.
Certification in Case Management.
Experience in Home Health, OASIS/MDS, Medicare/Medicaid, or face-to-face member interactions.
Reliable home internet.

Responsibilities

Conduct home visits for onboarding and regulatory assessments.
Complete Health Risk Assessments (HRAs) according to members’ assigned frequency.
Complete new Personal Care Attendant (PCA) assessments using the integrated time-for-task tool and conduct yearly PCA reevaluations.
Submit yearly MDS assessments and assessments when a member experiences a significant change in status.
Provide education about the NaviCare case management program.
Conduct telephonic or virtual assessments when appropriate.
Collaborate with the Care Team.
Complete LTSS evaluations and collaborate with Utilization Management.
Conduct in-home assessments using motivational and culturally sensitive interviewing.
Perform medication reconciliation.
Complete state-required assessment tools per contract.
Conduct functional assessments for LTSS programs.
Participate in training and audits.
Maintain program and policy knowledge to educate members.
Support HEDIS, Medicare 5 Star, and other initiatives.
Drive a personal motor vehicle as an essential function of the position.