Nurse Case Manager - Senior Care Options - North Shore
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 role completes in-person Health Risk Assessments (HRAs) at the frequency assigned to members, new Personal Care Attendant (PCA) assessments using the integrated time-for-task tool, and yearly PCA reevaluations. The position is also responsible for timely and accurate submission of yearly MDS assessments and assessments when a member experiences a significant change in status. Assessments are primarily in person but may sometimes be completed by phone or virtually. The Nurse Case Manager provides education about the NaviCare case management program, collaborates with the Care Team, and completes Long-Term Services and Supports (LTSS) evaluations in collaboration with Utilization Management (UM). The role conducts member assessments, medication reconciliation, functional assessments, and State-required assessment tools, while supporting quality initiatives including HEDIS and Medicare 5 Star.
Requirements
- Graduate from an accredited school of nursing.
- Active, unrestricted Registered Nurse license in Massachusetts.
- At least 1 year of clinical RN experience with complex medical, behavioral, and social comorbidities.
- Ability to conduct in-person and telehealth assessments.
- Ability to work on interdisciplinary teams.
- Skill in screening social determinants of health.
- Strong communication and interviewing skills.
- Problem-solving skills and adaptability.
- Knowledge of regulatory requirements or willingness to learn them.
- Valid driver’s license.
- Must attest to having no disqualifiers under the Driver Safety Policy.
- Must possess and provide proof of minimum state-required auto insurance.
- Must have reliable transportation.
- Driving a personal motor vehicle is an essential job function.
Nice To Haves
- Bachelor’s or advanced degree in nursing or a health care-related field.
- Certification in Case Management is strongly desired.
- 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) and Personal Care Attendant (PCA) assessments, including yearly PCA reevaluations.
- Submit yearly MDS assessments and assessments when there is a significant change in member status.
- Provide education on the NaviCare case management program and maintain program and policy knowledge to educate members.
- Conduct telephonic or virtual assessments when appropriate.
- Collaborate with the Care Team and with Utilization Management on LTSS evaluations.
- 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.
- Support HEDIS, Medicare 5 Star, and other initiatives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
