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Job description
Overview
nAbout us:
nFallon 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.
nBrief summary of purpose:
nThe 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.
nResponsibilities
nOverview
nnnConducts home visits for onboarding and regulatory assessments.
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nnCompletes HRAs and PCA assessments.
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nnSubmits MDS assessments.
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nnProvides education on NaviCare case management program.
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nnConducts telephonic assessments when appropriate.
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nnCollaborates with Care Team.
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nnCompletes LTSS evaluations and collaborates with UM.
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n nMember Assessment, Education & Advocacy
nnnConducts in-home assessments with motivational and culturally sensitive interviewing.
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nnPerforms medication reconciliation.
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nnCompletes State-required assessment tools per contract.
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nnConducts functional assessments for LTSS programs.
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nnParticipates in training and audits.
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nnCompletes telephonic/virtual assessments.
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nnMaintains program/policy knowledge to educate members.
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nnSupports HEDIS, Medicare 5 Star, and other initiatives.
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n nQualifications
nEducation:
nGraduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred.
nLicense :
nActive, unrestricted license as a Registered Nurse in Massachusetts
nCertification :
nCertification in Case Management strongly desired
nOther : Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:
nnnMust possess a valid drivers’ license
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nnMust attest to no disqualifiers per Driver Safety Policy
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nnMust possess and provide proof of minimal state required auto insurance
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nnMust have reliable transportation
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n nExperience:
nnn1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
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nnAbility to conduct assessments in-person and telehealth.
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nnAbility to work on interdisciplinary teams.
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nnSkill in screening social determinants of health.
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nnStrong communication and interviewing skills.
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nnProblem-solving skills and adaptability.
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nnKnowledge or willingness to learn regulatory requirements.
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nnPreferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.
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nnReliable home internet.
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n nPay Range Disclosure:
nIn accordance with the Massachusetts Wage Transparency Act, the pay range for this position is around $96,000 - $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.
nFallon 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.
n#P01
nLocation US-MA-Framingham
nPosted Date 3 weeks ago (9/17/2026 6:09 PM)
nJob ID 8493
n# Positions 1
nCategory Professionals
Worksite address
framingham, MA, 01704, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.