Nurse Case Manager - Community Care and Medicare - Hybrid Remote

Job title: Nurse Case Manager - Community Care and Medicare - Hybrid Remote in Worcester, MA at Fallon Health
Company: Fallon Health
Job description: ResponsibilitiesJob Responsibilities:Member Assessment, Education, and Advocacy

• Telephonically assesses and case manages a member panel
• May conduct in home face to face visits for onboarding new enrollees and reassessing members, utilizing a variety of interviewing techniques

Provider Partnerships and Collaboration

• May attend in person care plan meetings with providers and office staff and may lead care plan review with providers and care team as applicable
• Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met

Regulatory Requirements – Actions and Oversight

• Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to product regulatory requirements and Program policies and processes
• Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams

QualificationsEducation:

• Graduate from an accredited school of nursing mandatory
• Bachelors (or advanced) degree in nursing or a health care related field preferred

License/Certifications:

• Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver’s license and reliable transportation
• Certification in Case Management strongly desired
• Satisfactory Criminal Offender Record Information (CORI) results

Experience:

• 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required
• Understanding of Hospitalization experiences and the impacts and needs after facility discharge required
• Experience working face to face with members and providers preferred
• Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking, required
• Home Health Care experience preferred

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Expected salary:
Location: Worcester, MA
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