Temp to Perm SCO Assessment Nurse Case Manager - Lowell - up to 6 months

Fallon Health • Worcester, MA

26d • Hybrid

About The Position

Fallon Health is a company that cares, prioritizing members and ensuring they receive the care they need and deserve. Founded in 1977, Fallon Health delivers equitable, high-quality, coordinated care and is consistently recognized for member experience, service, and clinical quality. The company values individual differences and strives 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 conduct in-person Health Risk Assessments (HRAs) based on assigned frequency, complete all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool, and perform 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 in-person but may occasionally be completed telephonically.

Requirements

• Graduate from an accredited school of nursing.
• Active, unrestricted license as a Registered Nurse in Massachusetts.
• 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.
• 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.

Nice To Haves

• Bachelors (or advanced) degree in nursing or a health care related field.
• Certification in Case Management.
• Home Health experience.
• OASIS/MDS experience.
• Medicare/Medicaid experience.
• 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: Mid Level