Nursing Jobs in Wellesley, MA
$95,000 - $100,000 / 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 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 around $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 
$70,699.20 - $136,801.60 / year
If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-23679 Facility: LOC0028 - 30 Reservoir Park Drive30 Reservoir Park Drive Rockland, MA 02370 Department Name: SSH VNA Team 2 Status: Full time Budgeted Hours: 40 Shift: Day (United States of America) The community health nurse is a professional nurse knowledgeable in community health nursing who provides nursing care to patients in the community setting. Compensation Pay Range: $70,699.20 - $136,801.60 1. Schedule Completes weekly schedule and makes scheduled home visits per assignment. Schedules and prioritizes nursing visits according to client acuity and in accordance with the organization's emergency preparedness plan 2. Assessment/Documentation Admission Visit For each admission to caseload, develops an individualized and holistic plan of care for the patient in collaboration with the patient/family/caregiver. Performs admission physical and psycho social assessment to determine appropriate plan of care. 3. Reassessment/Visit Documentation For each visit, demonstrates the skills and judgment necessary to implement the plan of care, nursing interventions, and procedures necessary for the skilled care of the patient, as evidenced by chart review and observation. Updates the plan of care on an ongoing basis as goals are met and problems are identified. 4. Discharge/Documentation Discharge For each discharge, documentation demonstrates improvement in outcomes or applicable variances are identified. Patients are appropriately prepared for discharge and all disciplines involved in the care of the patient are in agreement with plan. 5. Medication Demonstrates knowledge of department policies and procedures for administering and documenting medications.Medication reconciliation is completed every visit and medication profile is reviewed and updated with changes as appropriate. DRR is run with each additional medication. Medication management is taught to each patient/family member each visit , including side effects. 6. Case Management The case manager demonstrates responsibility and accountability for coordinating the plan of care for each patient on caseload. The patient /family is involved and participates in the plan of care. Communicates with all disciplines to insure quality of care. 7. Safety Awareness Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment. Complies with current hand hygiene and infection control guidelines. 8. Professional Development Responds to and participates in opportunities to maintain, enhance, and promote the image of the professional nurse. 9. Leadership Development Serves in a formal or informal leadership role 10. Advanced Clinical Skills Responds to and participates in opportunities to demonstrate the use of individual advance clinical skills and advance clinical knowledge. Assumes overall responsibility for own professional development by incorporating knowledge of evidence-based practice and research into clinical practice Graduate of an accredited School of Nursing. Bachelor of Science degree in nursing from a college/university accredited by the NLN is preferred. Minimum Work Experience One to two (1–2) years of medical/surgical nursing experience is preferred. Write, speak, understand English. Basic Nursing competencies. M-F 8-430 1 weekend every 4th 1 holiday per year Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: RN-Registered Nurse - Board of Registration in Nursing (Massachusetts) 
