Senior Care Options Nurse Case Manager - Southeast Worcester County - Flexible Remote
Company: Fallon Community Health Plan
Location: Worcester
Posted on: June 24, 2022
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Job Description:
Senior Care Options Nurse Case Manager - Southeast Worcester
County - Flexible RemoteUS-MA-WorcesterJob ID: 6856Type: Full Time#
of Openings: 1Category: NursingFallon Health - Corp HQOverviewThis
Senior Care Options Nurse Case Manager is covering Southeast
Worcester County including Southeastern Worcester Country; Milford,
Blackstone, Uxbridge region, extending into Franklin. Fallon Health
Vaccination Requirements:To protect the health and safety of our
workforce, members and communities we serve, Fallon Health now
requires all employees to disclose COVID-19 vaccination status. As
of 2/1/2022 all roles not designated as "Remote" require full
COVID-19 vaccination and Fallon Health will obtain the necessary
information from candidates prior to employment to ensure
compliance. Failure to meet the vaccination requirement may result
in rescission of an employment offer or termination of employment.
About Fallon Health:Founded in 1977, Fallon Health is a leading
health care services organization that supports the diverse and
changing needs of those we serve. In addition to offering
innovative health insurance solutions and a variety of Medicaid and
Medicare products, we excel in creating unique health care programs
and services that provide coordinated, integrated care for seniors
and individuals with complex health needs. Fallon has consistently
ranked among the nation's top health plans, and is accredited by
the National Committee for Quality Assurance for its HMO, Medicare
Advantage and Medicaid products. For more information, visit
www.fallonhealth.org.About NaviCare:Fallon Health is a leader in
providing senior care solutions such as NaviCare, a Medicare
Advantage Special Needs Plan and Senior Care Options program.
Navicare integrates care for adults age 65 and older who are dually
eligible for both Medicare and MassHealth Standard. A personalized
primary care team manages and coordinates the NaviCare member's
health care by working with each member, the member's family and
health care providers to ensure the best possible outcomes.
Summary:The Nurse Case Manager (NCM) is an integral part on an
interdisciplinary team focused on care coordination, care
management and improving access to and quality of care for Fallon
members. NCM seeks to establish telephonic and/or face to face
relationships with the member/caregiver(s) to better ensure ongoing
service provision and care coordination, consistent with the member
specific care plan developed by the NCM and Care Team.
Responsibilities may include conducting in home face to face visits
for member identified as needing face to face visit interaction and
assessments with the goal to coordinate and facilitate services to
meet member needs according to benefit structures and available
community resources. The NCM may conduct assessments and may
determine the number of hours' members require for MassHealth
programs such as the personal care attendant program, adult foster
care, group adult foster care, and other programs per product
benefits and guidelines. The NCM may utilize an ACD line to support
department and incoming/outgoing calls with the goal of first call
resolution with each interaction.ResponsibilitiesMember 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, including motivational interviewing, and
employs culturally sensitive strategies to assess a Member's
clinical/functional status to identify ongoing special conditions
and develops and implements an individualized, coordinated care
plan, in collaboration with the member, the Clinical Integration
team, and Primary Care Providers, Specialist and other community
partners, to ensure a cost effective quality outcomeCare
Coordination and Collaboration:Provides culturally appropriate care
coordination, i.e. works with interpreters, provides communication
approved documents in the appropriate language, and demonstrates
culturally appropriate behavior when working with member, family,
caregivers, and/or authorized representativesWith member/authorized
representative(s) collaboration develops member centered care plans
by identifying member care needs while completing program
assessments and working with the Navigator to ensure the member
approves their care planProvider 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
applicableDemonstrates 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 Other:Performs other responsibilities as assigned
by the Manager/designeeSupports department colleagues, covering and
assuming changes in assignment as assigned by
Manager/designeeQualificationsEducation:Graduate from an accredited
school of nursing mandatory and a Bachelors (or advanced) degree in
nursing or a health care related field preferred.
License/Certifications:License: Active, unrestricted license as a
Registered Nurse in Massachusetts & current Driver's license and a
vehicle to be used for home visitsCertification: Certification in
Case Management strongly desiredOther: 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
requiredUnderstanding of Hospitalization experiences and the
impacts and needs after facility discharge requiredExperience
working face to face with members and providers preferredExperience
with telephonic interviewing skills and working with a diverse
population, that may also be Non-English speaking, requiredHome
Health Care experience preferredEffective case management and care
coordination skills and the ability to assess a member's activities
of daily function and independent activities of daily function and
the ability to develop and implement a care plan that meets the
member's need working in partnership with a care team
preferredFamiliarity with NCQA case management requirements
preferredCompetencies:Demonstrates commitment to the Fallon Health
Mission, Values, and VisionSpecific competencies essential to this
position:Asks good questionsCritical thinking skills, looks beyond
the obviousProblem SolvingAdaptabilityHandles day to day work
challenges confidentlyWilling and able to adjust to multiple
demands, shifting priorities, ambiguity, and rapid
changeDemonstrates flexibilityWritten CommunicationIs able to write
clearly and succinctly in a variety of communication settings and
styles 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. JT18PI183012510
Keywords: Fallon Community Health Plan, Worcester , Senior Care Options Nurse Case Manager - Southeast Worcester County - Flexible Remote, Executive , Worcester, Massachusetts
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