Fallon Health

Manager

• Telephonically assesses and case manages a member panel
• May conduct in home face to face visits for onboarding new enrollees and reassessing members
• Establishes telephonic and/or face to face relationships with the member/caregiver(s) to ensure ongoing service provision and care coordination
• Develops and implements individualized, coordinated care plans in collaboration with members, Clinical Integration team, Primary Care Providers, Specialists and community partners
• Performs medication reconciliations
• Performs Care Transitions Assessments per Program and product line processes
• Completes NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when indicated
• Maintains up to date knowledge of Program and product line benefits, Plan Evidence of Coverage details, and department policies and processes
• Serves as an advocate for members and facilitates access to community resources when needs are not covered by Fallon Health
• Authorizes and coordinates healthcare services in compliance with documented care plan goals and regulatory standards
• Assesses member disease and medication management knowledge and provides education to increase self-management
• Collaborates with interdisciplinary team to identify and address high risk members and to provide disease management information
• Educates members on preventative screenings and other health care procedures according to protocols
• Ensures members/PRAs participate in development and approval of their care plans
• Strictly observes HIPAA regulations and Fallon Health confidentiality policies
• Provides culturally appropriate care coordination, working with interpreters and communication in appropriate languages
• Manages NaviCare and ACO members in conjunction with Navigators, Behavioral Health Case Managers, Social Care Managers, and community partners
• Monitors progression of member goals and care plan goals and provides feedback to care team
• Works collaboratively with Fallon Health Pharmacist for medication review referrals
• Develops and fosters relationships with members, family, caregivers, vendors and providers to streamline care
• May attend and lead in-person care plan meetings with providers and office staff
• Completes Program Assessments, Notes, Screenings, and Care Plans in the Centralized Enrollee Record according to regulatory requirements
• Supports Quality and Ad-Hoc campaigns and completes other responsibilities as assigned by Manager/designee

Senior Care Options Nurse Case Manager, Spanish Preferred