Senior Care Options Assessment Nurse Case Manager - Cape Cod
About The Position
The Assessment Nurse Case Manager will be covering and visiting members in Cape Cod. Fallon Health is a company that cares, prioritizing members to ensure they receive necessary care. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. The company believes its individual differences, life experiences, knowledge, self-expression, and unique capabilities allow it to better serve its members, embracing and encouraging diversity. Today, guided by its mission of improving health and inspiring hope, Fallon Health strives to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and completes regulatory assessments. The Assessment Nurse Case Manager completes in person Health Risk Assessments (HRAs) in accordance with members assigned frequency. The Assessment Nurse Case Manager completes all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool and well as yearly PCA reevaluations. The Assessment Nurse Case Manager is also responsible for the timely and accurate submission of yearly (and when there is a significant change in status) MDS assessments. Assessments are done primarily in person but may at times be completed telephonically.
Requirements
- Graduate from an accredited school of nursing mandatory
- Active, unrestricted license as a Registered Nurse in Massachusetts
- 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
Nice To Haves
- Bachelors (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 interactions experience
- Reliable home internet
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.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
