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RN Nurse Case Manager

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POST DATE 9/10/2016
END DATE 11/12/2016

Fallon Health Worcester, MA

Worcester, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree



* Working directly with members, their physicians, and other care managers to assess the needs of high-risk members and develop customized, proactive care plans resulting in the member attaining and/or maintaining an optimal functional status. Performs medication reconciliations.

* Authorizing services, coordinating care, ensuring timeliness and coordinating healthcare services, in compliance with documented care plan goals and objectives, and Department and regulatory standards, seeking supplemental benefit and/or community services when appropriate or needed. Refers to and works with Department Social Workers on member specific care plans.

* Working with the members to assist with learning how to self-manage his or her health needs, social needs or behavioral health needs.

* Working independently and collaboratively as a facilitator with other members of the health care team to ensure that members receive quality, cost-appropriate care.

* In conjunction with both internal and external customers, the Case Manager promotes and works towards achieving the goals and objectives of the Care Services Department and Fallon Health Plan.



Graduate from an accredited school of nursing and a Bachelors (or advanced) degree in nursing a health care related field preferred, or Graduate of a social worker program with a Bachelor s degree in social work, psychology or related field.


Active licensure as a Registered Nurse (RN) in Massachusetts in Massachusetts

Certification in Case Management (CCM) or Certification in Managed Care Nursing (CMCN) a plus.


* 3-5 years clinical experience as a Registered Nurse managing chronically ill high-risk patients OR as a social worker in a clinical setting

* Home Health Care experience a plus

* 1 year experience as a case manager in a managed care setting preferred

* Excellent (verbal and written) communication and organizational skills.

* Is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change.

* Shows resilience in the face of constraints, frustrations, or adversity.

* Comprehends the difference between a managed care philosophy and a fee-for-service mentality in a health care delivery system.

* Familiar with the Case Management Society of America and/or New England s definition and mission of case management

* Familiar with NCQA case management requirements

* Familiarity with provisions of governmental and accrediting agency health plan requirements.

* Ability to follow the logical management of a member s care throughout the continuum of care.

* Computer literacy required.

* Good interpersonal and telephonic assessment skills.

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).