Nursing Jobs in Forestdale, MA
$95,000 - $100,000 / year
Overview The Assessment Nurse Case Manager will be covering and visiting members in Cape Cod. About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. 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. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive 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. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Brief summary of purpose: 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. Responsibilities Overview 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. Member Assessment, Education & Advocacy 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. Qualifications 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 Certification : Certification in Case Management strongly desired Other : Driving your personal motor vehicle is an essential job function of this position and the following requirements apply: 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 Experience: 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. Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions. Reliable home internet. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. 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. #P01 $95,000 - $100,000 / year
Overview The Nurse Case Manager will be covering and visiting members in Cape Cod. About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. 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. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive 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. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Brief summary of purpose: 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 tstructures 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. Responsibilities Note: Job Responsibilities may vary depending upon the member’s Fallon Health Product 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, 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 outcome Performs medication reconciliations Performs Care Transitions Assessments – per Program and product line processes Utilizing clinical judgment and nursing assessment skills, may complete NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when a member’s medical/functional status changes that warrants a change in rating category to ensure members are in the correct State defined rating category Maintains up to date knowledge of Program and product line benefits, Plan Evidence of Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives Assesses the Member’s knowledge about the management of current disease processes and medication regimen, provides teaching to increase Member/caregiver knowledge, and works with the members to assist with learning how to self- manage his or her health needs, social needs or behavioral health needs Collaborates with appropriate team members to ensure health education/disease management information is provided as identified Collaborates with the interdisciplinary team in identifying and addressing high risk members Educate members on preventative screenings and other health care procedures such as vaccines, screenings according to established protocols and program processes such initiatives involving Key Metrics outreach Ensures members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team Strictly observes HIPAA regulations and the Fallon Health Policies regarding confidentiality of member information Supports Quality and Ad-Hoc campaigns Care 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 representatives With 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 plan Manages NaviCare members in conjunction with the Navigator, Behavioral Health Case Manager, Aging Service Access Point Geriatric Support Service Coordinator, contracted Primary Care Providers and others involved/authorized in the member’s care Manages ACO members in conjunction with the Navigator, Social Care Managers, ACO Partners, Community Partners, Behavioral Health Partners and others involved/authorized in the member’s care Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member’s health care goals and needs Works collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining the focus of the Member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care Actively participates in clinical rounds 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 Performs other responsibilities as assigned by the Manager/designee Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee Qualifications 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 Certification : Certification in Case Management strongly desired Other : Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation 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• Effective 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 preferred• Familiarity with NCQA case management requirements preferred Performance Requirements including but not limited to: • Excellent communication and interpersonal skills with members and providers via telephone and in person• Exceptional customer service skills and willingness to assist ensuring timely resolution• Excellent organizational skills and ability to multi-task• Appreciation and adherence to policy and process requirements• Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education• Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties• Willingness to learn insurance regulatory and accreditation requirements• Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word • Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables• Accurate and timely data entry• Effective 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 • Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria • Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Competencies: • Demonstrates commitment to the Fallon Health Mission, Values, and Vision• Specific competencies essential to this position: Problem Solving Asks good questions Critical thinking skills; looks beyond the obvious Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifing priorities, ambiguity, and rapid change Demonstrates flexibility Written Communication Is able to write clearly and succinctly in a variety of communication settings and styles. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. 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. #P01 $95,000 - $115,000 / year
Purpose of Position: The primary purpose of this position is to supervise the day-to-day nursing activities of the unit during your tour of duty. Such supervision must be in accordance with current federal, state, and local standards, guidelines, and regulations that govern our facility, and as may be required by the Director of Nursing Services, to ensure that the highest degree of quality care is maintained at all times. Description Assist the Director of Nursing Services in directing the day-to-day functions of the nursing activities in accordance with current rules, regulations, and guidelines that govern the long-term care facility by assisting with development, maintenance, and updating written policies and procedures that govern the day-to-day functions of the nursing service department. Oversee and ensure all nursing service personnel comply with the procedures set forth in the Nursing Service Procedures Manual. Interpret the department’s policies and procedures to personnel, residents, visitors, and government agencies as required. Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, completing accident/incident reports as necessary etc., as necessary. Attends and is an active participant in various committee meetings of the facility (i.e., Infection Control, Policy Advisory, Pharmaceutical, Quality Assessment, Care Plan Committee, etc.) as required and is prepared to implement recommendations as instructed by the Director. Make recommendations to the Director the equipment needs of the nursing services department keeping within budgetary guidelines and regulations. Ensure that an adequate stock level of medications, medical supplies, equipment, etc., is maintained on premises at all times to meet the needs of the resident. Assist the Maintenance Director in developing a preventive maintenance program for maintaining the nursing service department’s equipment and supplies in a safe and operable manner. Ensures that care plan and assessment duties, are performed in accordance with the Unit Manager job description. Assist the Resident Assessment/Care Plan Coordinator in: planning, scheduling, and revising the MDS; including the implementation of RAPs and Triggers. Must maintain the confidentiality of all resident care information including protected health information. Report known or suspected incidents of unauthorized disclosure of such information; and adhere to Resident’s rights. Performs other work related / personal nursing care duties as requested. Qualifications Must possess, as a minimum, a Nursing Degree from an accredited college or university, or be a graduate of an approved LPN/LVN program. Must have, as a minimum, one (1) year of experience as a supervisor in a hospital, nursing care facility, or other related health care facility. Must have training in rehabilitative and restorative nursing practices. Must possess a current, unencumbered, active RN/ LPN license to practice as an RN or LPN in this state. BLS /CPR and AED Program Certification is required. Must be able to read, write, speak, and understand the English language. Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served. Be a supportive team member, contribute to and be an example of team work and team concept. Must possess the ability to make independent decisions when circumstances warrant such action. Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities. Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel. Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care. Must have patience, tact, a cheerful disposition and enthusiasm, as well as the willingness to handle difficult residents. Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices. Must be able to relate information concerning a resident’s condition. Must not pose a direct threat to the health or safety of other individuals in the workplace. Must be able to lift a minimum of 50 pounds and meet all other Physical and Sensory requirements of the job. Schedule Details: Full-time, Monday-Friday, Occasional Evenings, Weekends and Holidays Organization : JML Care Center Primary Location : Massachusetts-Falmouth Department : JML-Nursing Administration Annual/Hourly: Annual - Based on Full Time Employment Hiring Pay Range: 95000 - 115000 
