Nursing Jobs in Shrewsbury, MA
$90,000 - $120,000 / year
Job Summary: The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage, scheduling coordination, provider and member engagement, centralized documentation, and escalations. Essential Functions: Conducts outreach to members and providers to confirm service details, coordinate scheduling, address general inquiries, and ensure accurate documentation of care coordination activities. Coordinate services by working with providers, community partners, and member/ caregivers to manage scheduling, service updates, and administrative changes, as needed Serves as a support resource for member and provider requests, escalations, or concerns by coordinating responses and ensuring issues are routed or addressed promptly Collaborates with the care team, providers, and other partners as needed to support member service requests and ensure smooth communication and continuity across care activities Initiate outreach to members, vendors, providers, and/or vendors/suppliers to follow up on non-clinical matters assigned by the Care Team (e.g., including authorization status, DME status, appointment scheduling and prescription assistance) Provide administrative support as assigned Assist members and the Care Team with solving health plan related concerns, i.e. claims follow up or prior auth status, etc. Help members schedule transportation to medical appointments; assist members with booking issues Support targeted member outreach campaigns when there is an event that has the potential to broadly impact our membership’s wellness, such as agency closures, hazardous/catastrophic events (e.g., power outages, fires, inundations) Coordinates interpreting and translation supporting services for the member (including ADA compliance) Obtain documents/forms that allow Care Team to speak with members and/or representatives on the member’s behalf in accordance with HIPAA laws – e.g., Release of Information (ROI), Oral Disclosure of Protected Health Information Assist leadership with the development, refinement and enhancement of programs, initiatives, processes, policies, workflows, and projects Mentor for new Care Navigation Specialist – during and beyond their orientation period, if needed Maintain accurate documentation and maintenance of member records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements Identify member and provider needs and facilitates referrals to appropriate internal teams such as care management or community-based support programs Performs any other job related duties as requested. Education and Experience: High School or GED required One (1) year of related experience in a health-related service field required Competencies, Knowledge and Skills: Critical thinking and troubleshooting skills Strong customer service and problem-solving skills Ability to work in multiple systems, often simultaneously Clear, concise, and effective oral and written communication Strong time management and demonstrated ability to work independently Flexibility to adapt to business needs Motivated team player Excellent organizational skills High attention to detail and accuracy Basic arithmetic skills required Proficiency in Microsoft Office Suite Licensure and Certification: None required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $90,000 - $120,000 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. 
$100,000 - $104,000 / 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, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality. Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, 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— in the region. Brief summary of purpose: Functions as a member of the PACE Interdisciplinary Team and provides social work services, support and counseling to participants, families and other caregivers. Supervises and directs the Social Work Department in accordance with accepted social work practice. Collaborates with IDT and SE management team to ensure utilization and MLR targets are met. Responsibilities Primary job responsibilities: Provides clinical services to participants and families in the form of psychosocial assessment and treatment. Provides on-going case management for participants as needs and status changes. Identifies and coordinates resources for participants and their families. Refers participants and their families to appropriate community/government agencies. Acts as advocate and liaison to obtain needed services. Participates in care planning, family meetings, enrollment/disenrollment, and reassessments of SE participants to meet regulatory requirements. Assures that participants rights are reviewed during the intake process. Participates in meetings, committees, in-services, orientation etc. as required. Participates in policy/procedure and job description development for Social Work Department. Establishes and maintains effective collegial relationships with interdisciplinary team members. Develops collaborative relationships with other health and human services agencies and community providers. Consults with and advises staff members of the relationship of social, emotional, and cultural factors of health and medical care. Participates in Quality Improvement initiatives. Encourages and facilitates subordinates’ ability to participate. Directly supervises and provides clinical supervision to other social workers. Interviews, hires, and trains employees. Conducts regular touchpoint meetings, completes performance appraisals, ensures employee competencies, and addresses employee relations issues immediately and directly. Keeps Site Director informed of all employee relations issues and other issues as necessary. Keeps current on changing rules and regulations regarding Medicare/Medicaid eligibilities. Communicates changes in regulations affecting the PACE program to Social Workers. Qualifications Education : Masters in Social Work License: Valid and unrestricted license to practice social work from the Board of Registration of Social Work of the Commonwealth of Massachusetts (i.e., LCSW or LICSW) 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: At least five years of experience in a social work capacity, preferably in a medical setting, with a minimum of 2 years of experience working with a frail or elderly population. At least 2 years of supervisory experience preferred. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is$ 100,000-$ 104,000 annually 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 
Overview Associate or bachelor's degree in nursing. Current RN license, specific to the state(s) you are assigned to work. One year of clinical RN experience in home health or hospice. One year of RN management experience. Current CPR certification. Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic. 
