SCO Assessment Nurse Case Manager

• Overview The Senior Care Options Assessment Nurse Case Manager will be covering and visiting members in Lowell.
• About us: Fallon Health is a company that cares.
• We prioritize our members—always—making sure they get 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 believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members.
• We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique.
• 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.
• Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
• Brief summary of purpose: The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and completes regulatory assessments.
• The Assessment Nurse Case Manager completes in person Health Risk Assessments (HRAs) in accordance with members assigned frequency.
• The Assessment Nurse Case Manager completes all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool and well as yearly PCA reevaluations.
• The Assessment Nurse Case Manager is also responsible for the timely and accurate submission of yearly (and when there is a significant change in status) MDS assessments.
• Assessments are done primarily in person but may at times be completed telephonically.

Responsibilities

Overview Conducts home visits for onboarding and regulatory assessments. Completes HRAs and PCA assessments. Submits MDS assessments. Provides education on NaviCare case management program. Conducts telephonic assessments when appropriate. Collaborates with Care Team. Completes LTSS evaluations and collaborates with UM. Member Assessment, Education & Advocacy Conducts in-home assessments with motivational and culturally sensitive interviewing. 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. Maintains program/policy knowledge to educate members. Supports HEDIS, Medicare 5 Star, and other initiatives.