RN ER Other
Heywood Healthcare

Registered Nurse, Emergency Room, Per Diem, Variable shifts, 16 hours per month minimum

$37.26 - $76.63 / hour

Overview

You Matter Here! Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter! 

 

Hours: Per Diem, Variable shifts, 16 hours per month minimum

 

$37.26 - $76.63

  Job Summary:Under the direction of the nurse manager, performs a variety of direct and indirect patient care activities based on standards defined by the Emergency Department. Ability to function independently in the Emergency Department. Assessment skills, critical thinking skills and communication skills a must as well as a team player. 

Responsibilities

Essential Functions 
  • Assesses (and reassesses), plans, implements, and evaluates nursing interventions/plans of care/patient goals.
  • Provides patient care based on standards of care, standards of practice, protocols, and established policies and procedures.
  • Respects each patient as an individual; provides care that fosters the patient’s sense of dignity and positive self-regard.
  • Provides patient/family teaching based on identified learning needs, readiness to learn, and barriers to learning.
  • Collaboratively plans and prepares patient/family for discharge incorporating support systems/resources as necessary
  • Appropriately delegates and supervises nursing interventions performed by others.
  • Appropriately prioritizes patient care (e.g. seeks assistance as needed from appropriate resources, reassigns personnel as necessary, recognizes need for emergency intervention, etc.).
  • Provides thorough, timely, and accurate documentation of all pertinent data, therapeutic interventions and patient responses according to established standards.
  • Provides timely and thorough report on assigned patients to other health care team members to ensure integration of services and continuity of patient care.
  • Promotes learning for colleagues and self (e.g. functions as preceptor, instructor, trainer, attends professional development programs, etc.).
  • Proactively identifies risk to patient safety and identifies opportunities to reduce medical/health care errors (i.e. appropriate reporting of errors/incidents). 
  • Identifies ethical issues in care and develops plan to address.
  • Safely administers medications and intravenous therapy in accordance with physician’s orders, protocols, policies and procedures.
  • Assesses patient pain level upon admission and as necessary, depending upon diagnosis utilizing the numerical pain scale.
  • Reassesses effectiveness of pain control and notifies physicians as needed, as well as, documents assessment and patients’ response to medication.
  • Performs and documents initial assessment upon patients’ arrival and implements triage protocols as needed.
  • Identifies patients at risk for potential/alleged abuse.
  • Initiates safety plans for domestic violence, child, and elder abuse patients.
  • Completes required mandated reporting in a timely manner.
  • Collects and documents forensic evidence as per policy.
  • Maintains chain of evidence per policy and procedures
  • Completes mandated reports for stabbings, gunshot wounds, burns, and sexual assault per policy and procedure.
  • Maintains knowledge of Disaster Policy and Procedure.
  • Identifies patient at risk for violent behavior and appropriately implements non-violent intervention (i.e. Code 100).
  • Demonstrates knowledge of the indications for, alternatives, monitoring and documentation of restraint to use.
  • Recognizes normal and abnormal laboratory and diagnostic results and appropriately notifies the physician of changes in a timely manner.
  • Safely administers vasoactive medications demonstrating understanding of dosage, action, use, side effects, and titration parameters associated with maintenance of critical drips.
  • Performs accurate and timely identification of cardiac arrhythmias.
  • Institutes, monitors, and documents thrombolytic and anticoagulation therapy standards and protocols.
  • Demonstrates skills associated with initiation and maintenance of the intubated patient including, suctioning, troubleshooting, and weaning.
  • Accurately interprets arterial blood gases, pulse oximetry, and clinical features of impaired gas exchange and/or airway clearance.
  • Responsible for obtaining supporting information and completing required documentation related to medication reconciliation for use by the Attending MD.
  • Responsible for implementing components of the VAP bundle consistently and per protocol. Responsible for alerting the Nurse Manager/Director/Nursing Supervisor if there is a deviation from VAP bundle by Attending MD for case review and follow up as indication.
Statement of Other DutiesThis document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.  Functional Demands Physical Requirements Exerts 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), handles (seizing, holding, grasping, turning, or working with hands), and feels (perceiving attributes of items such as size, shape, temperature, or texture by means of fingertips). Occasionally stoops (bending the body downward and forward by bending the spine at the waist), kneels (bending the legs at knee to come to rest on knee or knees) and distinguishes colors.  Organizational Expectations Behavioral Attributes The following behavioral attributes are required: achievement motivation, concern for order, flexibility, initiative, self-confidence, customer service oriented, interpersonal effectiveness, teamwork, analytical thinking and information seeking.

Qualifications

Job Requirements Minimum Education
  • AS in nursing required, BS in nursing preferred.   
Minimum Work Experience
  • 3-5 years ED experience preferred.
 Minimum Licenses and Certifications
  • Registered Nurses, Current MA license
  • ACLS upon hire OR must hold an active BLS card and obtain AHA ACLS within 60 days of hire
  • AHA PALS within six (6) months of hire 
  • TNCC, ENPC and CEN preferred

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

IntelyCare

Registered Nurse (RN)

$56 - $60 / hour
Earn as much as $60 an hour as a Registered Nurse (RN) in and around Northborough, Massachusetts, and take back control of your schedule. That's because at IntelyCare, you can choose the shifts at any of our partner facilities that fit the best with your lifestyle. In addition to our commitment to a healthy work-life balance, we provide the security and professional support of W2 employment. With this kind of flexibility, in addition to eligibility for healthcare coverage and other important benefits, you'll be able to coordinate your shifts with classes at the University of Massachusetts - Boston, take your kids to Assabet Park during the hot summer months, or spend more time relaxing with a good book at your favorite Main Street coffee shop. You deserve a job that finally supports your life, not the other way around. See what other fantastic perks and benefits we offer. Benefits RN pay: $56 to $60 per hour Rates that are up to 25% higher on average Opportunities for overtime and boosted rates on holidays Multiple pay options — weekly and daily pay available Employer tax withholding each pay period Quickly see shifts in any state where you're authorized to practice Work whenever you choose by selecting your preferred shifts at any facility in our partner network Your choice of day/evening/overnight shifts, weekday/weekend shifts, and more Eligibility for 401k retirement plan Coverage for workers' comp and malpractice insurance (employer paid) Tuition discounts at Excelsior University (up to 34%) for undergraduate and graduate programs Ongoing opportunities to upskill with a dedicated team of QA nursing professionals Eligibility for health, dental, and vision insurance (includes qualifying family members) An all-in-one app where you can manage your shifts and access workplace perks like free CE courses At IntelyCare, you get a job and a schedule that you manage, but also a supportive community that has your back. Here's how some of our own nursing professionals have described the experience: "I love working with IntelyCare because of all the perks and benefits it provides. There are a variety of facilities to choose from in the app. At first I was going to multiple facilities until I found my two favorites, where I now work full time. I love it!" "I love how flexible this job is! I am a busy mom, so accepting last minute ‘hero’ shifts typically works out better than scheduling shifts in advance. I appreciate the pay and the additional bonuses." "IntelyCare has exceptionally high rates, a variety of facilities, and an easy and fun app to use. The staff here are all very personable and knowledgeable as well, which makes things so much easier. This is truly a 5-star agency." "I love IntelyCare because everything has been easy from the application process until now. There has never been a question unanswered, and everyone is always happy to help with whatever I needed. They always advocate on our behalf. I am so grateful to be an IntelyPro." Job Responsibilities Providing resident-focused, high-quality care while working as a RN in post-acute facilities Developing individualized care plans for residents in coordination with the wider medical team Reviewing care options with clinicians, nursing staff, residents, and their family members Setting up and using medical equipment and devices as needed for effective care Administering medications and providing treatments to residents consistent with their care plan Measuring and monitoring resident vital signs and drawing fluids as needed for labs and testing Ensuring accurate documentation of relevant information such as interventions and responses, vital signs, and resident medical histories Training and supervising nursing professionals and support staff as needed, consistent with scope of practice limitations Supporting staff with incident investigations and reporting Being accountable to follow and adhere to resident care plans Delivering care consistent with all applicable laws, policies, and standards of care Qualifications and Skills Current Massachusetts state license to practice as a Registered Nurse (RN) Successful completion of an approved nursing program Minimum of 6 months of experience ( RN or related role) Advanced skills in multitasking, organization, and communication Ability to lift a minimum of 50 lbs Get the Flexibility You Need and the Support You Deserve As you compare Registered Nurse (RN) jobs in your area, consider joining a company that was created with professionals like you in mind. Get the work-life balance and peace of mind you deserve by joining the team ranked #1 in quality today. COVID-19 Considerations: COVID-19 vaccination requirements vary by state. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Location: Northborough, Massachusetts 01532
IntelyCare

Registered Nurse (RN) - Hospital/ Acute

$40 / hour
Earn as much as $40 an hour as a Registered Nurse (RN) in Worcester, MA, and the wider region, in a W2 position (with benefits) where you can decide when, where, and how often you'd like to work. The nurses who founded our company knew the burden of inflexible schedules and mandatory overtime and wanted something better for their colleagues. With IntelyCare you can use our mobile-friendly app to easily pick your preferred shifts at any of our partner facilities, customize your pay, and access any one of our many employee benefits. If you're ready for a better work-life balance, in fact a work-life balance that you get to set, then come see what it's like to schedule work around your life. Do you enjoy starting the day with a refreshing bike ride along Lake Quinsigamond? Would you like the freedom to take time off to chaperone you child's upcoming field trip to the Worcester Art Museum? With IntelyCare you can do all of this — and so much more. Here are a few more reasons why you may want to consider joining our amazing team. Benefits Registered Nurse (RN) hourly pay range: $40 Customized pay periods which include the option of getting paid daily Availability of hazard, travel, holiday, and overtime pay Your choice of contracts at acute care facilities in your area and the ability to easily find contracts in multiple states based on your licensing Tuition discounts of up to 34% at Excelsior University (undergraduate and graduate programs) Health, dental, and vision coverage for you and qualifying family members Retirement plan eligibility (401k) Employer-paid coverage for malpractice insurance and workers' compensation Employer withholding of taxes Easy management of work schedules and benefits and access to free training resources through our mobile-friendly app At IntelyCare we trust our nursing professionals and clinicians and value their feedback. Want to know what they think about working for us? Here's what a few of them had to say about their experience: “I am making more money than I’ve ever made before, while making my own schedule, and still being able to stay close to home. I love working with IntelyCare!” “This job feels unreal sometimes! Being able to make your own schedule is great, but working at different facilities and learning new things every day makes it even better. It helps you increase your skill set in a way that being a FT employee somewhere could never do. I truly feel blessed to be part of this team!” “IntelyCare is extremely flexible! I always find shifts I can work after dropping my kids off at school and I am finally able to attend all their sports events schedules without putting my job at risk. The customer service makes it even better because everybody is always sweet and respectful. They’re always there to assist you with any problem you may have.” “Working for IntelyCare changed my whole outlook on the medical field! You guys make me want to work, feel motivated to come in every day and do my best to give the best care possible. The IntelyCare team is amazing! You never know what they have in store for their employees (bonuses, giveaways and etc…).” Job Responsibilities Delivering timely and efficient patient care within your scope of practice Assessing patient conditions in a timely manner and assisting the clinical team in prioritizing care Being accountable to follow and adhere to patient care plans Providing emergency and triage care and assisting in medical procedures to stabilize patients Initiating IV lines and assisting with intubations and defibrillations Administering and titrating medications as prescribed and in coordination with the clinical team Monitoring changes in patient conditions and patient responses to interventions Tracking and recording patient vital signs and test results to identify baselines and bases for interventions Coordinating in the development, implementation, and revision of patient care plans Explaining procedures to patients and their loved ones and relaying concerns to the broader care team Ensuring compliance with all applicable standards of care and facility policies and procedures as well as HIPAA requirements Qualifications and Skills Current Massachusetts state Registered Nurse (RN) license Min. 8 months experience working as an RN Successful completion of a nursing program from an approved institution (BSN preferred) Certification in BLS and ACLS from an approved organization Immunizations based on location and facility requirements Ability to lift a minimum of 50 lbs Compliance with, and completion of, a standard background check Get the Work-Life Balance You Deserve — and More If you're looking for Registered Nurse (RN) jobs in your area, our team is ready to hear from you. Build your career with a job that doesn't force you to choose between work and your personal life — apply to the team ranked #1 in quality today. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Location: Worcester, MA 01608
IntelyCare

Registered Nurse (RN)

$54 - $65 / hour
Start making as much as $65 an hour as a Registered Nurse (RN) in Milford, NH, and the surrounding area in a job with a completely flexible schedule. On our team you get to choose only the shifts you want at our partnering facilities, and also enjoy the security, support, and benefits of W2 employment. As a nurse-founded company, we know the struggle of trying to squeeze in life's important moments around a demanding and inflexible schedule. That's why our founders created a business model that allows nursing professionals to set their own work-life balance. Schedule your shifts around your life, instead of the other way around, and take extended vacations whenever it suits you. Maybe you could free up more weekdays off for fishing with your kids at Osgood Pond, or recharging at Purgatory Falls. Choose shifts around the Milford Pumpkin Festival and the other festivities you enjoy, without stressing over how to fit it all in. When you manage your own time, you can work as much — or as little — as you prefer. Check out the other exciting benefits, below, and consider joining our team of dedicated professionals today. Benefits Registered Nurse (RN) hourly pay range: $54-$65 (25% higher than average) Your choice of facilities and shifts (weekends, overnight, per diem, etc.) Get paid weekly or even daily Employer-paid taxes, workers' comp, and malpractice insurance Health, vision, and dental benefits for employees and qualified family members Retirement benefit (401k) eligibility User-friendly mobile app to track shifts and access other job functions Overtime, holiday, and hazard pay, plus bonus pay for travel Training and continuing education, for free, through the mobile app Complementary water bottles, scrubs, and other IntelyCare merch At IntelyCare, we put our nurses first, something that they see as soon as they come on board. A few of our "IntelyPros" wanted to share some highlights of their experience with us. Here's what they had to say: "I love having the flexibility IntelyCare has given me... My average pay has increased tremendously and being paid daily has taken a lot of stress off my life. I’m extremely thankful for this job!" "I love working with IntelyCare! No one else pays better; there is a wide range of shifts available in my area; they usually answer any requests/questions in a timely manner; and the app is super easy to use." "IntelyCare is an awesome company to work for! The pay and the facilities they partner with are incredible, and the customer service is next level." "IntelyCare values our worth and shows appreciation for the work we do! Everyone is so helpful and willing to help – I can always connect with someone when I need to. Working with this company has released a lot of stress from my life!" Job Responsibilities Providing high-quality nursing care in post-acute facilities, such as SNFs and ALFs Administering individualized treatments and medications to residents Developing care plans in conjunction with residents and medical teams Setting up medical equipment and monitoring their use Going over care options with residents and family members Meeting and consulting with physicians and other healthcare staff as needed Drawing blood, urine, and other fluid samples for lab work Making sure nursing standards and facility policies are met Accurately documentating interventions and medical condition histories Helping with investigations into incidents, ensuring they're reported accurately Training nursing staff and supervising them Qualifications and Skills Current New Hampshire state license to practice as a Registered Nurse (RN) Completion of an approved nursing program Experience in either post-acute care or in-patient hospital settings (at least 4 months) Excellent organizational skills Ready for a Job That Puts Your Needs First? As you search for Registered Nurse (RN) jobs in your area, you don't have to settle for the work-life imbalance that you may be used to. If you're ready for something better, we're ready for you. Take the next step today by applying to the team ranked #1 in quality. COVID-19 Considerations: Clinicians must be vaccinated against Covid-19. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Fallon Health

Medicare/Community Care Nurse Case Manager - Hybrid Remote

$88,000 - $95,000 / year
Overview 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. Summary of purpose: 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. Responsibilities may include regular telephonic assessments, care planning and identifying member specific priorities, and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The NCM must be familiar with quality metrics including STARS and HEDIS as well as guiding factors within the NCQA standards. Emphasis is placed on complex case management, reducing readmission rates and ensuring that members’ needs are met at time of transition from ER/inpatient hospitalization to home. The NCM must understand the effect that social determinants of health have on health outcomes, identify barriers to remaining safe in the community and align members with community supports to meet SDOH needs. The NCM is also required to have an understanding of the benefit structure for both Medicare and Community Care. Responsibilities Primary Job Responsibiities Note: Job Responsibilities may vary depending upon the member’s Fallon Health Product Member Assessment, Education, and Advocacy Telephonically assesses and manages a member panel Conducts cold calls to members identified as having a potential need for case management Regular assessment of members’ needs, utilizing a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a member’s clinical/functional status to identify ongoing special conditions and develops and implements an individualized, coordinated care plan, in collaboration with the member, the support team, community resources and providers Performs medication reconciliations Performs Care Transitions Assessments – per program and product line processes Assesses for risk for readmission utilizing tools like PointClickCare Participates in multidisciplinary rounds Ensure members preventive health metrics are complete to close HEDIS gaps in care Creates complex care plans and assessment in accordance with NCQA standards Maintains up to date knowledge of product line benefits, Plan Evidence of Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights for both Medicare and Community Care Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives Assesses the member’s knowledge about the management of current disease processes and medication regimen, provides teaching to increase member/caregiver knowledge, and works with the members to assist with learning how to self-manage his or her health needs, social needs or behavioral health needs Collaborates with appropriate team members to ensure health education/disease management information is provided as identified Identifies and refers members to other Fallon Health products as appropriate Must maintain working knowledge of all products offered at Fallon Health, including but not limited to NaviCare, ACO and Summit Collaborates with the interdisciplinary team in identifying and addressing high risk members Educate members on preventative screenings and other health care procedures such as vaccines, screenings according to established protocols and program processes such initiatives involving Key Metrics outreach Identifies SDOC needs and appropriately collaborates with community partners to ensure needs are being met Manages members who are at risk for Medication non-compliance by working closely with the Fallon pharmacy team and outreaching members as needed Strictly observes HIPAA regulations and the Fallon Health Policies regarding confidentiality of member information Supports Quality and Ad-Hoc campaigns Care Coordination and Collaboration Provides culturally appropriate care coordination, i.e. works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers, and/or authorized representatives With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs Manages members in conjunction with the Navigator, Behavioral Health Case Manager, and community supports as appropriate Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member’s health care goals and needs Works collaboratively with Fallon Health Pharmacy team, referring members in need of medication review based upon member need Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining the focus of the member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care Acts as an advocate for members ensuring that their medical needs are being met in an effective manner Identifies social determinate of health needs and works cohesively with the care team and external supports to help close these disparities Actively participates in clinical rounds Provider Partnerships and Collaboration Ensures providers are updated with any critical health issues Advocates for member needs with providers as needed Educates members on quality gaps in care as needed Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met Familiarizes oneself with multiple provider and facility electronic medical records to obtain and review member records Regulatory Requirements – Actions and Oversight Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to product regulatory requirements and Program policies and processes Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams Familiarizes oneself with CAHPS questions to better ready members for survey Is a subject matter expert in Complex Case Management to meet NCQA standards Performs other responsibilities as assigned by the Manager/designee Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee Qualifications 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/Certifications License: Active, unrestricted license as a Registered Nurse in Massachusetts Certification : Certification in Case Management strongly desired Other: Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation Experience: 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, that may also be non-English speaking, required Home Health Care experience preferred Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need working in partnership with a care team preferred Familiarity with NCQA, CAHPS and Stars/HEDIS metrics preferred Performance Requirements including but not limited to: 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 including but not limited to: self-study, mentoring, classroom, and group education Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties Willingness to learn insurance regulatory and accreditation requirements Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables Accurate and timely data entry Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Competencies: Demonstrates commitment to the Fallon Health Mission, Values, and Vision Specific competencies essential to this position: Problem Solving Asks good questions Critical thinking skills, look beyond the obvious Adaptability Handles day-to-day work challenges confidently Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change Demonstrates flexibility Written Communication Able to write clearly and succinctly in a variety of communication settings and styles Oral Communication Able to effectively communicate with members, providers and community supports Effective interviewing skills to draw information from members to create cohesive and effective care plans Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $95,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P02
Fallon Health

Senior Care Options Nurse Case Manager - Worcester

$95,000 - $100,000 / year
Overview The Nurse Case Manager will be covering the Worcester area. 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 Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. NCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the NCM and Care Team. Responsibilities may include conducting in home face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit tstructures and available community resources. The NCM may conduct assessments and may determine the number of hours’ members require for MassHealth programs such as the personal care attendant program, adult foster care, group adult foster care, and other programs per product benefits and guidelines. The NCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Note: Job Responsibilities may vary depending upon the member’s Fallon Health Product Member Assessment, Education, and Advocacy Telephonically assesses and case manages a member panel May conduct in home face to face visits for onboarding new enrollees and reassessing members, utilizing a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a Member’s clinical/functional status to identify ongoing special conditions and develops and implements an individualized,coordinated care plan, in collaboration with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome Performs medication reconciliations Performs Care Transitions Assessments – per Program and product line processes Utilizing clinical judgment and nursing assessment skills, may complete NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when a member’s medical/functional status changes that warrants a change in rating category to ensure members are in the correct State defined rating category Maintains up to date knowledge of Program and product line benefits, Plan Evidence of Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives Assesses the Member’s knowledge about the management of current disease processes and medication regimen, provides teaching to increase Member/caregiver knowledge, and works with the members to assist with learning how to self- manage his or her health needs, social needs or behavioral health needs Collaborates with appropriate team members to ensure health education/disease management information is provided as identified Collaborates with the interdisciplinary team in identifying and addressing high risk members Educate members on preventative screenings and other health care procedures such as vaccines, screenings according to established protocols and program processes such initiatives involving Key Metrics outreach Ensures members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team Strictly observes HIPAA regulations and the Fallon Health Policies regarding confidentiality of member information Supports Quality and Ad-Hoc campaigns Care Coordination and Collaboration Provides culturally appropriate care coordination, i.e. works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers, and/or authorized representatives With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs while completing program assessments and working with the Navigator to ensure the member approves their care plan Manages NaviCare members in conjunction with the Navigator, Behavioral Health Case Manager, Aging Service Access Point Geriatric Support Service Coordinator, contracted Primary Care Providers and others involved/authorized in the member’s care Manages ACO members in conjunction with the Navigator, Social Care Managers, ACO Partners, Community Partners, Behavioral Health Partners and others involved/authorized in the member’s care Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member’s health care goals and needs Works collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining the focus of the Member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care Actively participates in clinical rounds Provider Partnerships and Collaboration May attend in person care plan meetings with providers and office staff and may lead care plan review with providers and care team as applicable. Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met Regulatory Requirements – Actions and Oversight Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to product regulatory requirements and Program policies and processes Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams Performs other responsibilities as assigned by the Manager/designee Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee Qualifications 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 Certification : Certification in Case Management strongly desired Other : Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation Experience: • 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, that may also be Non-English speaking, required• Home Health Care experience preferred• Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need working in partnership with a care team preferred• Familiarity with NCQA case management requirements preferred Performance Requirements including but not limited to: • 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 including but not limited to: self-study, mentoring, classroom, and group education• Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties• Willingness to learn insurance regulatory and accreditation requirements• Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word • Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables• Accurate and timely data entry• Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need • Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria • Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Competencies: • Demonstrates commitment to the Fallon Health Mission, Values, and Vision• Specific competencies essential to this position: Problem Solving Asks good questions Critical thinking skills; looks beyond the obvious Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifing priorities, ambiguity, and rapid change Demonstrates flexibility Written Communication Is able to write clearly and succinctly in a variety of communication settings and styles. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #P02