Nurse Case Manager - Senior Care Options - North Shore

Fallon Health•Lynn, MA

About The Position

The Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard members and conduct regulatory assessments. The role completes in-person Health Risk Assessments (HRAs) at assigned intervals, new Personal Care Attendant (PCA) assessments using the integrated time-for-task tool, and annual PCA reevaluations. The nurse is also responsible for timely and accurate submission of annual MDS assessments and assessments following significant changes in member status. Assessments are primarily in person but may sometimes be completed by telephone or virtually. The role provides education about the NaviCare case management program, performs medication reconciliation and functional assessments for long-term services and supports (LTSS), and collaborates with the Care Team and utilization management. The Nurse Case Manager uses motivational and culturally sensitive interviewing, maintains knowledge of program policies and regulatory requirements, and supports HEDIS, Medicare 5 Star, and other initiatives. Driving a personal motor vehicle is an essential job function. The position pays $95,000–$100,000 per year; final compensation depends on experience, skills, and fit with the role’s responsibilities.

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 and attestation to having no disqualifiers under the Driver Safety Policy.
Proof of at least the minimum state-required auto insurance.
Reliable transportation.

Nice To Haves

Bachelor’s 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 interaction experience.
Reliable home internet.

Responsibilities

Conduct home visits for onboarding and regulatory assessments.
Complete Health Risk Assessments (HRAs) and Personal Care Attendant (PCA) assessments, including annual PCA reevaluations.
Submit annual MDS assessments and assessments following significant changes in member status in a timely and accurate manner.
Educate members about the NaviCare case management program.
Conduct telephonic or virtual assessments when appropriate.
Collaborate with the Care Team and utilization management.
Conduct in-home assessments using motivational and culturally sensitive interviewing.
Perform medication reconciliation.
Complete State-required assessment tools in accordance with contract requirements.
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.