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RN Clinical Manager (NaviCare)-Behavioral Health Team

Company: Fallon Health
Location: Worcester
Posted on: April 13, 2018

Job Description:


Team Management:

* Hires, orients, supervises, evaluates, counsels and terminates staff that function within the assigned NaviCare Program Team


Oversees performance of Team ensuring Departmental goals are met * Establishes productivity and professional goals with NaviCare Clinical Leadership Team and evaluates staff performance based on these defined goals

* Ensures department team members work collaboratively with members of the FCHP Utilization management Department assists the Team with discharge planning for Program Enrollees/situations

* Educates Team on workflows as appropriate and ensures they are following as appropriate Facilitates and/or conducts staff meetings on at least a monthly basis

* Meets 1:1 with Team members at least monthly and more frequently based upon need

* Ensures accuracy of Team member Access Data Base and documentation platform system(s)

* Acts as a resource and educator for the department staff

* Ensures staff utilize an effective communication style and methods to engage Enrollee s in care management Ensures team does not easily give up and works to engage Enrollee s as appropriate

* Evaluates staffing and operational needs to ensure that the day-to-day operations of the department are carried out in compliance with departmental and health plan budgetary requirements

* Creates reports to monitor staff productivity and performance and works with Team to ensure effectiveness and efficiencies

* Performs and/or ensures Team performs quality and inter-rater reliability audits on a regular basis to assure compliance with the department s policies and procedures

* Resolves conflicts among participants in the care planning process

* Manages department budget, ensuring forecasts are updated per Fallon Health process

Program Leadership Activities:

* Documents and updates department workflows and organizes in an easy to find manner

* Develops and conducts education/training sessions regarding the program as required

* Works with Regional Director to develop, create, and/or disseminate reports to effectively manage and continuously improve the Program

* Works with the Regional Director to create and implement policies/procedures/workflows as appropriate

* Represents the department interdepartmentally and with external customers as requested

* Participates in regulatory reporting and meeting initiatives as required

* Develops, and Coordinates Program External Quality Review Performance Improvement Projects as required by Program Contracts (EOHHS and CMS)

* Identifies and shares best practices and innovative care management strategies with the team


Provider/Vendor Management and Coordination:

* Collaborates with vendors/providers such as the Aging Service Access Point Staff and Long term Care Facility Staff to ensure the NaviCare Enrollee care needs are met

* Leads vendor relationships with designated Aging Service Access Point Agencies and other contracted providers to ensure an effective and positive relationship between organizations


* Works collaboratively and cohesively with all members of the care team (both internal and external staff and providers)

* Maintains an ongoing awareness of clinical, social, and financial resources available in the community as well as State/Federal and national resources

* Supports department colleagues, covering and assuming changes in assignment as assigned by Regional Director/Designee

* Strictly observes HIPPA regulations and the Fallon Health policies regarding confidentiality of member informationPerforms other responsibilities as assigned by the Regional Director/Designee


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

License: Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver s license

Certification: Certification in Case Management strongly desired


A minimum of two years of supervisory or management experience in a health care setting; preferably with experience supervising/managing a mix of clinical and non-clinical staff.

A minimum of three to five years clinical experience as a Registered Nurse managing patients of all ages with health care problems/concerns.

Three years experience as a case manager performing care coordination in a managed care setting.

Experience working in a healthcare setting as a member of a professional clinical team required.

Experience in home health care, long term care and experience with the MDS 3.0 and HC forms a plus

Experience caring for MassHealth and Medicare Enrollees who are diagnosed with health conditions or chronic diseases, including mental illness or substance use disorders a plus.


Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester, RN Clinical Manager (NaviCare)-Behavioral Health Team, Executive, Worcester, Massachusetts

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