Nursing Jobs in Gardner, MA
$110,000 - $115,000 / year
Overview 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 Clinical Documentation Review RN is responsible for auditing care plans, health risk assessments, MDS assessments and other clinical documentation to ensure accuracy, completeness, and compliance. This role supports quality of care and regulatory adherence by reviewing documentation against CMS and state contractual guidelines. The reviewer provides feedback and guidance to clinical teams to promote accurate, consistent and compliant documentation that reflects the member’s health status and care needs. Responsibilities Primary Job Responsibilities: Audits documentation ensuring documentation meets quality standards and interventions and actions are effective to meet member needs Conduct audits of medical records to verify that documentation supports the services provided, meets regulatory standards, and aligns with SCO program requirements. Ensure interdisciplinary care plans are updated and reflect current member needs and are in compliance with regulatory and accreditation requirements. Confirm that assessments are documented and integrated into care planning. Audit MDS-HC forms entered into the State’s System to ensure compliance with current Supplemental Instructions Audit documentation for evidence of care coordination across medical, behavioral health, and long-term services. Ensure transitions of care (e.g., hospital discharge) are documented with follow-up plans and communication between providers. Identify documentation gaps that may impact care coordination, reimbursement, or compliance with MassHealth, CMS, and SCO-specific guidelines. Collaborate with providers and care teams to clarify clinical documentation through queries and feedback, ensuring accurate reflection of patient acuity, diagnoses, and care plans. Monitor trends and patterns in documentation errors or omissions and recommend corrective actions or process improvements. Educate clinical staff on best practices for documentation, including SCO-specific standards, regulatory updates, and audit findings. Participate in interdisciplinary and team meetings to provide insight into documentation quality and contribute to care planning and compliance strategies. Maintain audit logs and reports to track findings, follow-up actions, and performance metrics related to documentation quality and integrity. Collaborate with departments throughout Fallon to ensure documentation aligns with company policies and procedures. 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/Certifications: License: Active, unrestricted license as a Registered Nurse in Massachusetts Certification : Certification in Case Management preferred Other: Satisfactory Criminal Offender Record Information (CORI) results, reliable transportation Experience: 4+ years job experience as a Registered Nurse working in a care management/care coordination role in a managed care payor operating a dual Special Needs Plan required. Experience with NCQA, CMS, and other required regulatory requirements and experience writing and developing policies and process documents required. Experience with developing audit tools, auditing team member performance, and working with staff to improve their performance preferred. Demonstrated proficiency including but not limited to: Ability to develop a system and process to objectively measure care management competencies and to hold team members accountable, including, but not limited to developing corrective action plans, as appropriate Ability to identify gaps in staff’s knowledge base and to design training materials to address those gaps Ability to teach others in an organized and structured manner utilizing adult learning principles and collaboration skills Advanced skills in software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Manipulation of Excel spreadsheets to manage work and exposure and familiarity with pivot tables desirable 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 Knowledgeable about medical record documentation Critical thinking skills for independent problem solving Prior experience with clinical documentation review, quality audits, or utilization review preferred. Familiarity with chronic disease management, care planning and transitions of care. Experience with Minimum Data Set- Home Care assessments and requirements associated with such. Access and ability to navigate the State’s Virtual Gateway platform for MDS-HC review and submission Excellent attention to detail, analytical skills, and ability to identify discrepancies in documentation. Proficiency with EMR systems and audit tools. Strong written and verbal communication skills; ability to provide constructive feedback to clinical staff. Strong knowledge and understanding of current State Supplemental Instructions for MDS-HC submission for rating category assignment Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $110,000 - $115,000 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. 
$116,958.40 - $210,516.80 / year
Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account. Exemption Status: Exempt Hiring Range: $116,958.40 - $210,516.80 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations . Schedule Details: Monday through Friday Scheduled Hours: Days, hours varies Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 10014 - 2340 Emergency Room This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. The Nurse Manager is responsible and accountable for the 24-hour planning, organizing, directing, and coordination of clinical and administrative performance of assigned unit(s). Facilitates collaboration with medical and administrative leadership to assure patient needs are met and evaluates nursing care and patient outcomes. The scope of responsibilities includes clinical and safety practices of nurses and other members of the clinical team, professional nursing practice, leadership and professional growth, human resource management, financial performance, system coordination and clinical performance (safety, satisfaction and quality) improvement. I. Major Responsibilities: Clinical Practice, Patient Flow, Patient Experience: 1. Leads with high reliability principles framework with goal of zero harm. 2. Is responsible for a positive work environment that is safe for patients, visitors and staff. 3. Accountable for clinical practice and deployment of resources at the unit level to ensure ongoing implementation of nursing process and adherence to standards. 4. Conducts daily patient care rounds, assessing patient care requirements and monitoring nursing & ancillary staff performance to achieve safe, cost effective and quality patient care. 5. Directs the oversight of clinical practice through continuity of nursing assignments to optimize the patient plan of care. 6. Responsible to oversee that the nursing process is being utilized for each patient and a plan of care is established, coordinated, and delivered to each patient and family. 7. Creates and sustains a collaborative, patient-focused environment supporting excellence in clinical and service practices. 8. Assures the efficient daily operations of assigned unit(s), including appropriate staffing levels, equipment and supplies, bed and/or examination room management, workflow and productivity to meet patient needs. 9. Implements nursing standards, policies and procedures. 10. Accountable to hold multidisciplinary rounds for team lead review of care plans on the unit with providers, nursing, and ancillary team. 11. Maintains compliance with regulatory standards including, but not limited to, JC and DPH. 12. Ensures unit-based standards of care are in accordance with departmental, organizational and/or compliance related standards. 13. Maintains and displays knowledge of current profession/clinical issues and practices through participation in professional organization and certification in field of nursing. 14. Demonstrates and role model’s principles of ethical professional nursing practice. 15. Participates in Nursing Staff Organization; a shared governance model of practice through membership in nursing leadership council. Represents the department of nursing in various committees and task force activities throughout the medical center. 16. Coordinates team huddles during the day and in the evening to review new admissions, patient progression towards goals and discharge plan. Reports significant huddle outcomes to unit-director. 17. Accountable to patient experience outcomes in designated area Leadership/Management, Human Resources 1. Responsible for appropriate staffing levels, scheduling, hiring, and budgeting. 2. Assesses candidates, through behavioral and peer interviewing, for appropriate positions within the unit and makes recommendations for hire, transfers, promotions and/or other staff changes. 3. Partners with Safety Specialists for orientation of new clinical staff. 4. Provides clinical and administrative oversight of all staff and completion of specific performance reviews. 5. Assures appropriate orientation, competence assessment, in-service training and continuing education for all staff. 6. Ensures the proper documentation for recruiting, on-boarding, evaluating and terminating staff are completed timely and thoroughly. (i.e. position requisition, orientation checklist, separation). 7. Assures licensing certification for all staff is current. 8. Ensures job descriptions are reflective of current job duties and responsibilities and performance evaluations are completed for staff timely according to HR policies. 9. Fosters an awareness of the diversity that exists within the organization and strives to increase it by including culture, ethnicity, gender and age; promoting an environment that is sensitive to the needs of diverse populations. 10. Leads and influences the development of staff by creating a practice climate of responsiveness and learning which supports retention and recruitment of competent nurses and team members. 11. Develops staff by assisting them to identify goals and appropriate opportunities for learning. 12. Provides forums for individual and team recognition. 13. Coaches and supports staff by removing barriers and addressing issues. 14. Promotes communication and feedback through regularly scheduled staff meetings and other venues. 15. Informs Director and Associate Chief Nursing Officer of staff concerns. 16. Maintains current knowledge of labor and employment laws impacting staff in own unit and/or those that impact areas across the medical center. Maintains knowledge of current union contracts within own area of responsibility. 17. Establishes a climate for open, two-way communication and builds relationships at all levels of the organization. 18. Develops, implements and updates recognition initiatives valued by the unit/area. 19. Ensures and is accountable to staff participation in Nursing Staff Organization Governance councils. 20. Accountable for staff attendance at in-service programs, teaching opportunities, staff meetings and rounding. 21. Uses tools such as employee surveys to measure staff morale with a focus toward recognition and developing action plans for improvements. Budgetary Planning and Financial Performance 1. Develops annual departmental budgets based on established patient care indicators, projected volumes and patient populations. 2. Maintains cost effective staffing patterns based on department of nursing approved staffing budgets. 3. Maintains master staffing plans, position control and produces monthly staffing schedule aligned with departmental standards. 4. Demonstrates fiscal responsibility via monitoring of salaries and supply expenses, prepares and submits Corrective Action Plans on time and on schedule. 5. Develops capital budgets in collaboration with medical staff for assigned units/areas. 6. Educates staff regarding unit and medical center budgets in order to promote awareness and instill accountability for the financial performance of the unit. Seeks medical leadership and staff feedback on changes that impact such performance. 7. Prioritizes projects in line with financial goals and resource allocation of staff and material. Quality, Safety and Experience Improvements 1. Responsible for VMS safety, quality idea boards on unit. 2. Accountable for the execution of daily and shift safety and clinical care huddles. 3. Rounds on existing and new patients, addressing issues or concerns of patients and/or families on the unit. 4. Responsible for the closure of Safety Intelligence reports and appropriate Corrective Action Plans in place. Responsible for reporting all Serious Reporting Events (SRE) to leadership and provide feedback to staff on results. 5. Links departmental goals to department of nursing/organizational goals and strategic plans. 6. Actively coordinates clinical quality improvement and safety efforts on the unit with defined medical center quality and safety goals. 7. Facilitates patient flow through timely admissions and discharges in collaboration with medical staff and case management to assure proper utilization of resources. 8. Works collaboratively to solve problems, improve processes and integrate services within the department and with other departments. 9. Develops and implements service initiatives on unit using/tailoring organizational tools and programs such as Because We Care, Our Commitments, etc. 10. Creates and sustains an environment that encourages feedback, problem-solving, self-evaluation and innovation as the way work is accomplished and improvements achieved. 11. Leads patient satisfaction initiatives at the unit level to address metrics identified below target goals. 12. Actively seeks information about the underlying needs of patients, families, and employees and seeks to match those needs. 13. Collaborates with other disciplines to ensure quality and continuity of care. 14. Communicates quality and safety reports to staff and facilitates active participation of staff to improve metrics and outcome measures. 15. Communicates the importance of Nursing Quality Indicators, Patient’s First Reports, Core Measures and patient satisfaction data to staff. 16. Submits data for annual PPR, corrective action plans and clinical performance metrics as identified by the Department of Nursing. 17. Articulates patient care standards as published by JC, CMS and professional nursing literature. 18. Understands, articulates, and ensures compliance with the State Nurse Practice Act, State Board of Nursing regulations, state and local regulatory agency standards and policies of the organization. 19. Supports initiatives to incorporate research and evidence-based practice knowledge into nursing practice. 20. Establishes and maintains effective relationships with community agencies, groups, professional affiliations, etc as appropriate. Encourages staff participation and support to meet community needs in conjunction with medical center initiatives. Standard Management Level Responsibilities: 1. Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities. 2. Develops and recommends the budgets for the areas managed. Manages activities to assure financial goals are met. 3. Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved. 4. Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives. 5. Encourages and supports diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc. 7. Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations. 8. Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements. 9. Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures. 10. Ensures adequate equipment and supplies for department. 11. Develops and maintains established departmental policies, procedures, and objectives. 12. Ensures compliance to all health and safety regulations and requirements. 13. Maintains, regular, reliable, and predictable attendance. 14. Performs similar or related duties as required or directed. All responsibilities are essential job functions. II. Position Qualifications: License/Certification/Education: Required: 1. Master of Science in Nursing (MSN), or Bachelor of Science in Nursing (BSN) with employee currently enrolled in a qualified MSN program. 2. Master’s Degree completion within 5 years of employment at Nurse Manager level. 3. Massachusetts Registered Nurse License. Experience/Skill: Required: 1. Broad and thorough knowledge of the discipline of Nursing. 2. Previous leadership/management experience. 3. Must possess the interpersonal and communication skills to provide effective participative leadership and to interact with patients, families, physicians, and other visitors and staff. 4. Strong analytical skills required to perform various data analysis techniques, review statistical and budgetary information and synthesize information appropriately. Preferred: 1. Minimum 3 years of directly related work experience in the field of specialty. Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements. Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents. III. Physical Demands and Environmental Conditions: Work is considered moderate, frequent walking, standing, lifting and potential exposure to hazardous materials including infectious diseases. Position requires work indoors in a patient care environment. Position requires use of computer, and therefore requires ability to use keyboard, printer, various information system programs (Onestaff, Visionware, Kronos). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day. As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law. If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible. 
