RN Case Manager - SCO program - Hybrid - Fall River
About The Position
The RN Nurse Case Manager is an integral member of an interdisciplinary team focused on care coordination, care management, and improving access to and quality of care for NaviCare members. The role establishes face-to-face and telephonic relationships with members and caregivers to support ongoing services and coordinate care consistent with member-specific plans developed with the care team. The Nurse Case Manager may conduct in-person visits for members who need face-to-face interaction and care planning, with the goal of coordinating services according to member needs, benefit structures, and available community resources. The position completes transition-of-care assessments in person or by telephone, reconciles medications at transitions, creates initial care plans, updates plans as needed, and carries out care-planning activities for medically complex members. The Nurse Case Manager collaborates with Navigators to address medical concerns and provide holistic, comprehensive case management.
Requirements
- Graduate from an accredited school of nursing; an associate’s degree is required.
- Active, unrestricted Registered Nurse license in Massachusetts.
- At least 1 year of clinical RN experience with complex medical, behavioral, and social co-morbidities.
- Ability to conduct assessments in person and via telehealth.
- Ability to work on interdisciplinary teams.
- Skill in screening social determinants of health.
- Strong communication, interviewing, and problem-solving skills, and adaptability.
- Knowledge of regulatory requirements or willingness to learn them.
- Must possess a valid driver’s license, attest to having no disqualifiers under the Driver Safety Policy, provide proof of at least the state-required auto insurance, and have reliable transportation.
- Reliable home internet.
Nice To Haves
- Bachelor’s degree or higher.
- Certification in Case Management; willingness to obtain certification when eligible.
- Experience in Home Health, OASIS/MDS, Medicare/Medicaid, or face-to-face member interactions.
Responsibilities
- Assess and manage a member panel through in-person and telephonic outreach.
- Complete medication reconciliations and care transition assessments.
- Educate members on benefits, rights, disease management, medications, and preventive screenings.
- Ensure members and authorized representatives participate in and approve care plans.
- Support member self-management through coaching and health education.
- Develop and update individualized care plans based on assessments.
- Coordinate services and authorize care according to program and regulatory standards.
- Collaborate with Navigators, primary care providers, Behavioral Health Case Managers, pharmacists, and community partners.
- Track progress toward goals and adjust care plans as needed.
- Participate in interdisciplinary rounds and team communication.
- Build strong relationships with members, caregivers, and providers to support coordinated, culturally appropriate care.
- Complete assessments, screenings, notes, and care plans within regulatory timelines.
- Follow HIPAA and organizational confidentiality policies.
- Support HEDIS, Medicare 5-Star, and quality initiatives through outreach and education.
- Assist with departmental campaigns, projects, and coverage as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
