Nursing Jobs in Lancaster, 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. 
$106,080 - $114,400 / year
Job Description Balance Life & Work with a New Career Opportunity (LONG TERM CARE) (SHORT TERM REHAB) (SKILLED NURSING) (SUB ACUTE CARE) Now Hiring - Unit Manager - Newton, MA Two Full Time Open Positions Min $106080K - Max $114400K Compensation will be based on, but not limited to, experience, qualifications, credentials and any other relevant information CareOne at Newton Job Duties The Unit Manager is responsible for the day-to-day coordination oversight of all aspects of his/her assigned clinical unit. Job duties include, but are not limited to: Ensure that required staffing levels are met for each shift on a daily basis needed to render care for the number of residents assigned to her/his responsibility. Make sure that staffing level adjustments are made each shift as needed and the Federal required posted schedule is adjusted to reflect current actual staffing. Attend, participate and lead the weekly resident "At Risk" meeting ensures resident care and condition concerns are identified, interventions are appropriate to cause and follow up is completed. Attend and participate in morning clinical review meeting. Attend and participate in PPS meetings as indicated. Attend and participate in monthly QA and A meetings, as assigned, and assist with follow up for any identified problems. Monitor provision of resident care by licensed nurses and C.N.A.'s ensure required documentation is completed. Review 24- hour resident change in condition report daily ensure necessary follow-up occurs including appropriate interventions implemented, physician and family notified and required documentation has been completed. Review resident medical records and documentation to ensure clinical programs are in place per policy and procedures. Identify educational needs of staff discuss findings with the Facility Educator and work collaboratively to meet these needs. Participate on other committees as requested by the Administrator/Director of Nursing Services. Ensure that resident care and documentation is in compliance with state and federal rules and regulations. Comply with and ensure that staff is in compliance with HIPAA rules and regulations, reporting any known violations to the Administrator and Director of Nursing Services. Ensure work assignments are made for assigned staff, including breaks and lunches and staff is compliant with assignments. Initiate disciplinary action as necessary for staff members in collaboration with DON/ADON. Communicate with the appropriate department manager/DON and participate with follow up and resolution to any grievances/concerns from personnel, residents or family members. Ensure physician orders are being followed. Assist the DON/ADON with preparing performance evaluations as directed. Greet new admissions and families and assist nursing staff with admission process as needed. Within 24 to 48 hours, ensure that all admission documentation is complete including all required clinical assessments and care plans. Monitor medication passes and treatment schedules to ensure that medications are being administered as ordered and that treatments are provided as scheduled. Provide direct nursing care as necessary. Report problem areas to the Director of Nursing. Assist in developing and implementing corrective action. Attend and participate in continuing education programs to remain current with standards of nursing practice and to maintain licensure requirements. Ensure that your nursing staff follows policy and procedures, including appropriate dress code. Ensure that nursing staff participate in all fire safety and disaster preparedness drills. Ensure that nursing personnel are follow established infection control procedures when isolation precautions become necessary. Ensure that all personnel operate nursing equipment in a safe manner. Participate as needed and/or directed in collaboration with the Resident Assessment/Care Plan Coordinator in the development of a written care plan (preliminary, interim and comprehensive for each resident that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished and which professional service is responsible for each element of care. Ensure that all nursing care is provided in privacy and that nursing service personnel knock before entering the resident's room. Report and assist with investigation of any allegations of resident abuse including misappropriation of resident property. Assist Social Services with ensuring that an Advance Directive/Code Status has been obtained and documented in appropriate places per policy. Participate in the annual survey and/or complaint survey processes as directed by Administrator/DON and assist as directed with any plans of correction required. Position Requirements Bachelor's degree preferred and/or must be a graduate of an approved RN program. Must be an actively licensed RN in assigned state(s) of employment Previous supervisory experience. Two years of LTC experience. Acute Care experience preferred. About Us The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees. We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees: Comprehensive Healthcare Benefits Multiple Medical Plans Including Pharmacy Including Teladoc Multiple Dental Plans Vision Plan Health Savings Account (eligibility restrictions apply) Flexible Spending Accounts Voluntary Life and AD&D Short-Term and Long-Term Disability Plans Hospital Indemnity Insurance Critical Illness Insurance Accident Insurance Whole Life Insurance Medicare Employee Assistance Legal Plan Commuter Benefits 401k Retirement Plan Employee Assistance Program (available to all employees) Paid Time Off Vacation Sick Plans in accordance with state laws Opportunities to advance and grow your career If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility! We are an Equal Opportunity Employer EEO/AA/M/F/DV 
Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities. 
