Senior Care Options Nurse Case Manager - Remote + In Home Visit - Worcester County
Fallon Health
2021-11-09T16:30:54Z
Worcester
Massachusetts
United States
Healthcare - Nursing
(No Timezone Provided)
Overview
Do you like to help senior (65+) patients/members but don’t want to be on the front lines? Do you have the organization, communication, and collaboration skills needed to help Care Manage our Navicare Fallon Health members to access, receive and coordinate their care? If yes, this remote role is for you!
This role is pivotal in case managing the care of our complex Navicare (age 65+) members. Duties include but are not limited to: telephonically assessing and case managing a member panel, conducting in home face to face visits for onboarding new enrollees and reassessing members annually, performing medication reconciliations, serving as an advocate for members to ensure they receive Fallon Health benefits as appropriate, educating members on preventative screenings and other health care procedures such as vaccines, and screenings, and ensuring members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team.
Do you have strong working knowledge of Nursing Care Plans, disease management and community resources? As well as proficiencies using Microsoft products including excel pivot tables? Are you organized and want to help patients without being on the front lines?
If yes, apply now and learn more about this role and our dynamic team!
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 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/Certifications
License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits
Certification : Certification in Case Management strongly desired
Other: Satisfactory Criminal Offender Record Information (CORI) results
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:Asks good questionsCritical thinking skills, looks beyond the obvious Problem Solving Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change Demonstrates flexibility Written CommunicationIs able to write clearly and succinctly in a variety of communication settings and styles 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.
Senior Care Options Nurse Case Manager - Remote + In Home Visit - Worcester County
Overview
Do you like to help senior (65+) patients/members but don’t want to be on the front lines? Do you have the organization, communication, and collaboration skills needed to help Care Manage our Navicare Fallon Health members to access, receive and coordinate their care? If yes, this remote role is for you!
This role is pivotal in case managing the care of our complex Navicare (age 65+) members. Duties include but are not limited to: telephonically assessing and case managing a member panel, conducting in home face to face visits for onboarding new enrollees and reassessing members annually, performing medication reconciliations, serving as an advocate for members to ensure they receive Fallon Health benefits as appropriate, educating members on preventative screenings and other health care procedures such as vaccines, and screenings, and ensuring members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team.
Do you have strong working knowledge of Nursing Care Plans, disease management and community resources? As well as proficiencies using Microsoft products including excel pivot tables? Are you organized and want to help patients without being on the front lines?
If yes, apply now and learn more about this role and our dynamic team!
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 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/Certifications
License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits
Certification : Certification in Case Management strongly desired
Other: Satisfactory Criminal Offender Record Information (CORI) results
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:Asks good questionsCritical thinking skills, looks beyond the obvious Problem Solving Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change Demonstrates flexibility Written CommunicationIs able to write clearly and succinctly in a variety of communication settings and styles 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.