Improving health and inspiring hope.
Medicare/Community Care Nurse Case Manager
Location
United States
Posted
6 days ago
Salary
$88K - $95K / year
Seniority
Lead
Job Description
Role Description
The Nurse Case Manager (NCM) is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members, specifically for Medicare and Community Care membership. The NCM seeks to establish telephonic relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with member specific needs and quality metrics developed by the NCM and support team.
- Regular telephonic assessments, care planning, and identifying member specific priorities.
- Familiarity with quality metrics including STARS and HEDIS as well as guiding factors within the NCQA standards.
- Emphasis on complex case management, reducing readmission rates, and ensuring that members’ needs are met at time of transition from ER/inpatient hospitalization to home.
- Understanding the effect of social determinants of health on health outcomes and aligning members with community supports.
Qualifications
- 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.
- Certification in Case Management strongly desired.
- Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation.
- 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 required.
- Home Health Care experience preferred.
- Effective case management and care coordination skills preferred.
- Familiarity with NCQA, CAHPS and Stars/HEDIS metrics preferred.
Requirements
- 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.
- Knowledgeable about software systems including Microsoft Office Products.
- Ability to effectively respond and adapt to changing business needs.
Benefits
- Pay range for this position is $88,000 - $95,000 per year.
- Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.
Job Requirements
- 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.
- Certification in Case Management strongly desired.
- Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation.
- 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 required.
- Home Health Care experience preferred.
- Effective case management and care coordination skills preferred.
- Familiarity with NCQA, CAHPS and Stars/HEDIS metrics preferred.
- 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.
- Knowledgeable about software systems including Microsoft Office Products.
- Ability to effectively respond and adapt to changing business needs.
Benefits
- Pay range for this position is $88,000 - $95,000 per year.
- Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.
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