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.
ResponsibilitiesOverview- 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.
QualificationsQualification requirementsEducation:RN's: Graduate from an accredited school of nursing, associates degree required, bachelor's or higher preferred
License/CertificationsLicense: RN Candidates (Required) Active, unrestricted license as a Registered Nurse in Massachusetts
Certification: Certification in Case Management strongly desired, willingness to obtain when eligible
Other: Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers' license
- Must attest to no disqualifiers per Driver Safety Policy
- Must possess and provide proof of minimal state required auto insurance
- Must have reliable transportation
Experience: - 1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
- Ability to conduct assessments in-person and telehealth.
- Ability to work on interdisciplinary teams.
- Skill in screening social determinants of health.
- Strong communication and interviewing skills.
- Problem-solving skills and adaptability.
- Knowledge or willingness to learn regulatory requirements.
- Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.
- Reliable home internet.
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.
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