SCO Assessment Nurse Case Manager - Lowell
About Us
Fallon Health is a company that cares, prioritizing our members to ensure they receive 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 embrace individual differences, life experiences, and unique capabilities to better serve our members. 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.
About the Role
The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and complete regulatory assessments. This role involves conducting in-person Health Risk Assessments (HRAs) according to assigned frequency, completing new and yearly Personal Care Attendant (PCA) assessments, and submitting timely and accurate MDS assessments. Assessments are primarily done in person but may occasionally be completed telephonically.
Responsibilities
- Conducts home visits for onboarding and regulatory assessments.
- Completes Health Risk Assessments (HRAs) and PCA assessments.
- Submits MDS assessments yearly and when there is a significant change in status.
- Provides education on the NaviCare case management program.
- Conducts telephonic assessments when appropriate.
- Collaborates with the Care Team and completes LTSS evaluations in coordination with Utilization Management (UM).
- Conducts in-home assessments using motivational and culturally sensitive interviewing techniques.
- 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 as needed.
- Maintains program and policy knowledge to educate members.
- Supports HEDIS, Medicare 5 Star, and other initiatives.
Qualifications
Education: Graduate from an accredited school of nursing is mandatory; a Bachelor’s (or advanced) degree in nursing or a healthcare-related field is preferred.
License: Active, unrestricted license as a Registered Nurse in Massachusetts.
Certification: Certification in Case Management is strongly desired.
Other Requirements:
- Must possess a valid driver’s license and attest to no disqualifiers per Driver Safety Policy.
- Must provide proof of minimal state-required auto insurance.
- Must have reliable transportation and home internet.
Experience:
- 1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
- Ability to conduct assessments in-person and via 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.
Pay
The pay range for this position is $95,000 - $100,000 per year. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.