RN Case Manager

Fallon Health•Worcester, MA

3d•$95,000 - $100,000

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 in-person and telephonic relationships with members and caregivers to support ongoing services and care coordination in accordance with individualized care plans developed with the care team. The Nurse Case Manager may conduct face-to-face visits and care planning for members who need in-person interaction, coordinating services according to member needs, benefit structures, and available community resources. The role completes transition-of-care assessments in person or by telephone and reconciles medications during transitions. It creates and updates care plans and carries out care-planning activities for medically complex members. The Nurse Case Manager collaborates with Navigators and other care partners to address medical concerns and provide holistic case management. The position requires driving a personal motor vehicle and reliable transportation.

Requirements

Graduate from an accredited school of nursing; an associate’s degree is required for RNs.
Active, unrestricted Massachusetts Registered Nurse license.
At least 1 year of clinical RN experience with complex medical, behavioral, and social co-morbidities.
Ability to conduct in-person and telehealth assessments.
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.
Valid driver’s license.
Must attest to having no disqualifiers under the Driver Safety Policy.
Must possess and provide proof of at least the state-required auto insurance.
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 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.
Conduct face-to-face visits and care planning for members identified as needing in-person interaction.
Reconcile medications at time of transition.
Create initial care plans, update care plans as needed, and execute care-planning activities for medically complex members.