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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

Company
Fallon Health
Job Classification
Full Time
Company Ref #
4540
AJE Ref #
576131847
Location
Worcester, MA
Experience
Entry Level (0 - 2 years)
Job Type
Regular
Education
Bachelors Degree

JOB DESCRIPTION

APPLY
RESPONSIBILITIES

* 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.





QUALIFICATIONS

Education:



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.



License/Cerfications:



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.



Experience:



* 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).