Nursing Jobs in Orleans, 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 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 $130,000 - $170,000 / year
Purpose of Position: Plans, organizes, budgets, directs and controls all activities of an assigned unit on a 24-hour, 7 day a week basis. Functions independently within broad scope of established policies and goals. Refers specific problems to the Vice President of Patient Care where clarification, interpretation, or exception to hospital policy, may be required. Description Manages overall operation of assigned unit and insures that needed and required policies, systems, procedures and standards are in effect and communicated to staff members on all shifts, and regularly reviews compliance through examination of records and reports, and discussion with supervisory and staff personnel. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence. Maintains current knowledge of Joint Commission and other applicable regulatory standards for assigned unit. Insures that policies and procedures are current, participates in inspections by Joint Commission, State Public Health representatives, makes corrections resulting from such surveys, and documents changes made and reports as required. Obtains legal policy advice as needed. Regularly updates knowledge of techniques and regulations appropriate to the age of the patients served on the particular nursing unit. Interviews, selects, orients, schedules and assigns unit personnel. Conducts performance evaluations of assigned personnel and contributes evaluation information on other personnel as appropriate. Conducts evaluations for new staff prior to completion of probationary period. Supervises and evaluates clinical activities of contracted licensed nurses working within their department and ensures contracted licensed nurses know current policies and procedures. Counsels employees, recommends various personnel actions, takes appropriate disciplinary action for infractions of policy, resolves conflicts among staff, and aids in resolution of grievances. Recommends positions and necessary staffing required, participates in preparation of unit operating and capital budgets, justifies need for additional staffing, reviews periodic performance reports to the budget, monitors patient charges and expenses, and maintains expenditures within allocated funds. Responsible for safety and comfort of patients and health and safety of employees and provides for orientation to and practice of emergency procedures, fire drills, evacuation procedures, and internal/external disaster plans and procedures. Provides for orientation to and compliance with all infection control policies and procedures. Collaborates with hospital support services to provide a safe, clean and secure environment for patients, staff and visitors. Evaluates and sets standards for unit facilities and equipment, and monitors utilization of equipment, supplies and utilities. Promotes open communication within the unit, department and with other units and departments. Plans and conducts unit staff meetings. Provides input and standards in formulating patient care policy and procedures. Works with medical staff to coordinate medical and nursing management of patient care. Utilizes and promotes Quality Improvement standards and practice. Supervises nursing activities related to patient care and sets standards for accurate reporting and recording of patients' symptoms, reactions and progress. Organizes patient care and ensures continuity of care based on physician orders and knowledge of clinical nursing needs of patients. Evaluates patient care through assessment, planning, intervention, re-evaluation, observation, written documentation, and comparison to established standards. Administers nursing care to patients, as needed, to maintain clinical skills and to assess particular patient requirements. Serves as clinical resource person and assists Nursing personnel in assessing patient/family status to plan nursing care. Communicates with family members and health professionals regarding care of patients. Serves as patient advocate within guidelines found in the Patient Bill of Rights. Interprets philosophy, goals, objectives, policies and procedures for personnel, patients, and the public. Provides for professional growth and development of nursing staff, encouraging formal and continuing education. Establishes climate conducive to meeting educational needs and efforts to unit. Provides direction to educational and teaching efforts of the department of the hospital. Cooperates with clinical instructors in planning, implementation and evaluation of clinical experience of affiliating students. Assumes responsibility for own personal continuing education and development needs; attends meetings, workshops and conventions to enrich personal knowledge, growth and skill in providing clinical care for patients. Serves as a resource to other units in clinical specialty. Serves on nursing committees, hospital committees, or professional nursing organizations. Fosters good public relations for unit, department and hospital. Assumes role of manager on designated weekends and holidays. Performs other work related management duties and activities as assigned or requested. Challenges current working practices identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence. Qualifications (RN) - Currently licensed as a Registered Nurse in the Commonwealth of Massachusetts (Preferred) – A Bachelor of Science in Nursing (BSN) (BLS) - Current Basic Life Support certification (ACLS) – Advanced Cardiac Life Support certification (obtain within 30 days of position start, offered within) Minimum of three years’ experience in hospital nursing, with demonstrated progression in responsibilities (De-escalation) - Completion of an approved De-escalation Certification Course (obtain within 90 days, offered within) Schedule Details Full-Time, M-F, Occ. Evenings, Weekends, & Occ. Holidays (Mugar 5) Organization : Cape Cod Hospital Primary Location : Massachusetts-Hyannis Department : CCH-Mugar 5 Annual/Hourly: Annual - Based on Full Time Employment Hiring Pay Range: 130000 - 170000 
