Nurse Case Manager - Community Care and Medicare - Hybrid Remote
Job title: Nurse Case Manager - Community Care and Medicare - Hybrid Remote in Worcester, MA at Fallon Health
Company: Fallon Health
Job description: ResponsibilitiesJob Responsibilities: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
- 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
- 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
- Graduate from an accredited school of nursing mandatory
- Bachelors (or advanced) degree in nursing or a health care related field preferred
- Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver’s license and reliable transportation
- Certification in Case Management strongly desired
- Satisfactory Criminal Offender Record Information (CORI) results
- 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