Nursing Jobs in Oxford, MA
Overview Associate or bachelor's degree in nursing. Current RN license, specific to the state(s) you are assigned to work. One year of clinical RN experience in home health or hospice. One year of RN management experience. Current CPR certification. Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic. $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 
$135,283.20 - $170,414.40 / year
Are you a current UMass Memorial Health caregiver? Apply now through Workday. Hiring Range: $135,283.20 - $170,414.40 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations . Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. The Psychiatric Nurse Practitioner, in consultation with the designated supervising psychiatrist, is primarily responsible for providing evaluation, brief treatment and medication prescription to the young adulthood through advanced age, and at any point along a physical continuum of the designated population. The need for psychiatric services may be generated by a primary mental health problem or secondary to co-existing health care problems. Provide psychiatric consultation as requested on medical / surgical units and in the Emergency Department Evaluate medical patients for psychiatric disorders, substance use disorders, risk assessments, decision-making capacity, behavior management, level of care assessments, provide medication and overall management recommendations. Work collaboratively with medical team to determine consultation questions and review findings to develop appropriate treatment plans. Provide support to Psychiatric Emergency Services team by assisting in evaluation of select patients and determination of appropriate disposition Supervision by Medical Director of Inpatient Psychiatry and Emergency Services; review cases Coordination with collateral contacts (family, police, state agencies, etc.) as needed Complete consultations within 24 hours; complete documentation and submit for billing Major Responsibilities: 1. Provides diagnostic and assessment services. Secures a health history from patient and/or family, records findings, and evaluates them. Performs a complete in-depth physical examination. Orders/performs pertinent diagnostic tests based on age and history. 2. Analyzes data collected to determine health status and identify differential diagnoses based on history, physical exam, and clinical findings. 3. Partners with physicians regarding proposed plan of care. Formulates this plan of care with the patient. 4. Manages therapeutic regime as outlined by established protocols for patients with acute illnesses. (Protocols are guidelines concerning patient care that are established between the physician and nurse practitioner. The guidelines outline subjective and objective findings, treatment plan and follow-up). Reassesses and modifies plan as necessary to achieve medical and health goals. Confers with physician for clinical direction as outlined by protocols. 5. Documents patient care outcomes to determine effectiveness of plan of care. Communicates outcomes with physician. 6. Signed delineation of privileges at hire between NP and collaborating physician. Must renew delineation of privileges each credentialing cycle including: scope of departmental practice treatment of emergencies physician consultation writing orders/prescription 7. Prescribes medications from Schedules II-VI. The form of prescription may be written or verbal via telephone order. Written prescriptions may be initiated by the nurse practitioner after obtaining proper registration numbers from the Massachusetts Department of Public Health and Drug Enforcement Agency. 8. Provides patient education. Acts as coordinator for admitting and discharging assigned patients. Works collaboratively with other health agencies and families of patients in the transition from admission to discharge. Confers with other health care providers including consultations and referrals to prepare a comprehensive patient care plan. 9. Within established protocols, under the supervision of the physician, nurse practitioners will assist with procedures in the operating room and with endoscopic procedures. 10. Enhances professional growth and development through participation in educational programs, current literature, in-service meeting and workshops. 11. Participates in department driven practices including on call scheduling, rotating weekends, etc. Ambulatory Care Nurse Practitioners: Completion of accredited program pertinent to the departmental needs (OB/GYN, Pediatrics, etc.) and has passed the appropriate certification exam. Partners with collaborating physician or designee as necessary with complexity of problems or plan of care Formulates plan of care with patient and multidisciplinary/interdisciplinary healthcare team Maintains department specific competencies that are degree specific, age specific to the discipline and license specific per certifying authority. Participates in department driven practices including on call scheduling, rotating weekends, etc. Acute Care Nurse Practitioners : Graduate of an approved Acute Care Nurse Practitioner program (ACNP) and has passed the ACNP board certification. Under the supervision of designated collaborating physicians, conduct comprehensive health assessments, analyze date and formulate clinical decisions to manage acute and chronic illnesses. Responds to sick calls of patients and treats them according to the acuity of illness. Participates in department driven practices including on call scheduling, rotating weekends, etc. Critical Care Nurse Practitioners: Graduates of an approved Acute Care Nurse Practitioner program (ACNP) and has passed the ACNP board certification. Under the supervision of designated collaborating physicians, conduct comprehensive health assessments, analyze date and formulate clinical decisions to manage acute and chronic illnesses. Performs procedures such as central line placement, insertion of arterial catheters, lumbar punctures, paracentesis and thoracentesis. Provides patient education and therapeutic management of the family in crisis related to critical illness. Maintains competencies as directed by the division. Rotation in the telemedicine intensive care unit (EICU-Hahnemann Campus) Standard Staffing Level Responsibilities: 1. Complies with established departmental policies, procedures and objectives. 2. Attends variety of meetings, conferences, seminars as required or directed. 3. Demonstrates use of Quality Improvement in daily operations. 4. Complies with all health and safety regulations and requirements. 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. 6. Maintains, regular, reliable, and predictable attendance. 7. Performs other similar and related duties as required or directed. All responsibilities are essential job functions. Position Qualifications: License/Certification/Education: Required: 1. Master's or doctoral degree. 2. Graduate of approved Nurse Practitioner program with certification. 3. Current Massachusetts license. Experience/Skills: Preferred: 1. 3-5 years of experience. Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements. Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day. As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law. If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible. 
