SCO Assessment Nurse Case Manager - Lawrence/Lowell

Fallon Health • Lawrence, MA

21h • Hybrid

About The Position

Fallon Health is a health plan founded in 1977 in Worcester, Massachusetts, dedicated to providing equitable, high-quality, coordinated care. The Assessment Nurse Case Manager is responsible for completing face-to-face home visits for new enrollees within 30 days of enrollment for onboarding and regulatory assessments. This role also involves completing in-person Health Risk Assessments (HRAs) according to assigned member frequency, conducting all new Personal Care Attendant (PCA) Assessments using an integrated time for task tool, and performing yearly PCA reevaluations. Additionally, the Assessment Nurse Case Manager is responsible for the timely and accurate submission of yearly Minimum Data Set (MDS) assessments and assessments following a significant change in status. While assessments are primarily conducted in person, some may be completed telephonically. Fallon Health values diversity and inclusion, striving to be a leading provider of government-sponsored health insurance programs.

Requirements

• Graduate from an accredited school of nursing, associates degree required.
• Active, unrestricted license as a Registered Nurse in Massachusetts.
• Certification in Case Management strongly desired, willingness to obtain when eligible.
• 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.
• Reliable home internet.

Nice To Haves

• Bachelor's or higher degree preferred.
• Home Health experience.
• OASIS/MDS experience.
• Medicare/Medicaid experience.
• Face-to-face member interactions experience.

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
• Education Level: Associate degree