Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.
About Fallon Health:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
Brief Summary of purpose:
The Nurse Case Manager Purpose is to:
Member Assessment, Education, and Advocacy
Care Coordination and Collaboration
The Nurse Case Manager goes to the member in the home to assess needs and monitor progress to goals as needed
Regulatory Requirements – Actions and Oversight
Provider Partnerships and Collaboration
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: 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
A minimum of one year of clinical experience as a Registered Nurse managing chronically ill/geriatric patients or related experience working in the NaviCare Program with the demonstrated ability to learn and apply nursing knowledge and skills with the guidance of a clinical mentor/preceptor. Working with Non-English speaking elder populations preferred.
Demonstrates proficiency including but not limited to:
Case management skills and care coordination skills