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13213 Jobs Found 

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Clinical Integration Nurse Case Manager

Fallon Health

Worcester, MA
1 day ago
Worcester, MA
1 day ago

Overview

Passionate about the Elderly? Looking for No Weekends/ No Holidays & Work/Life Balance? Interested in Case Management and stepping away from bedside care? Looking for Career Development?  Fallon's Nurse Case Manager is the position for you!

 

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About NaviCare:

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.

 

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 structures 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/Certifications

License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits

Certification: Certification in Case Management strongly desired

Other: Satisfactory Criminal Offender Record Information (CORI) results

 

Experience

 

  • 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required

 

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.

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Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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C

Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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C

Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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C

Product Release Specialist (11:00AM-7:30PM)

Cytiva

Worcester, MA
9 days ago
Worcester, MA
9 days ago

Help us improve access to life-changing therapies that can transform human health
We are Cytiva, a global provider of technologies and services that advance and accelerate the development and manufacture of therapeutics. Formerly part of GE Healthcare, we have a rich heritage tracing back hundreds of years, and a fresh beginning since 2020.
Our customers undertake life-saving activities. These range from fundamental biological research to developing innovative vaccines, biologic drugs, and novel cell and gene therapies. Our job is to supply the tools and services - the pots, pans, soups and sauces - they need to work better, faster and safer, leading to better patient outcomes.
We are looking for a Product Release Specialist to work with our expert Quality Assurance team of employees across the world. Do you have a passion for Quality? Then we would love to hear from you.
What you’ll do

  • Responsible for quality release of finished good products to packaging for shipment.
  • Analyze and review manufacturing and test data in written or electronic form to verify accuracy and completeness necessary for the final release. This also includes subcontractor records when product is processed by a 3rd party (i.e. sterilizer records).
  • Create tasks in electronic batch record data collection system to resolve product and process discrepancies.
  • Issue Certificate of Quality for final product release when all release requirements have been verified and met.
  • Provide consultation and guidance to other groups concerning documentation completeness, accuracy as well as related manufacturing quality management systems and processes.
  • Collaborate timely with Cross functional teams to aid effective investigations & problems solving
  • Interface with manufacturing to coordinate product release activities to best support production build and shipping schedules.
  • Provide input for deviations and product concessions. Support Quality Assurance Engineers with deviation, investigation, and rework documentation review.
  • Continually identify, recommend and implement process improvements with a lean and quality focus.
  • Comply with EHS regulations & policies.
  • Responding to routine quality related queries from other departments.
  • Monitoring and aiding the implementation of continuous improvements and process changes to ensure these are implemented in compliance with GMP.


Who you are

  • Demonstrated knowledge of Quality Management System Tools and continuous improvement methodologies.
  • Demonstrated collaboration, negotiation & conflict resolution skills.
  • Effective communication skills (written and oral).
  • Ability to multi-task & handle tasks with competing priorities effectively.
  • Technical aptitude (i.e. able to read & comprehend technical documentation & execute procedures).
  • Experience with generating, tracking and interpreting quality metrics.
  • Demonstrate support to a positive quality culture
  • 1-year experience in a medical device or pharmaceutical industry.
  • 1-year experience with CA/PA systems, including complaint handling.
  • Thorough familiarity with cGMPs of sterile product manufacture.
  • Knowledge of relevant Electronic Management Systems transactions and familiarity with Excel / Word packages.


Who we are
Whatever your role, we bring purpose and challenge into our everyday work. If you are driven to make the world a better place thanks to science and medicine, you’ll feel right at home here. If you’re flexible, curious and relentless, you’ll belong. If you are excited about a global culture, this can be the place to further your career.
Want to know more? Experience life at Cytiva on our Careers website, Instagram channel and LinkedIn page!
Cytiva is a 3.5 billion USD global life sciences leader with over 7000 associates across 40 countries who are dedicated to our mission to help us improve access to life-changing therapies that transform human health. As a trusted partner to customers that range in scale and scope, Cytiva brings efficiencies to research and manufacturing workflows, ensuring the development, manufacture and delivery of transformative medicines to patients.
Cytiva is part of the Danaher family of companies, a global science and technology innovator committed to helping customers solve complex challenges and improving quality of life around the world.

Danaher Corporation and all Danaher Companies are equal opportunity employers that evaluate qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The “EEO is the Law” poster is available here.

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Clinical Integration Behavioral Health Case Manager

Fallon Health

Worcester, MA
3 days ago
Worcester, MA
3 days ago

Overview

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

 

Brief summary of purpose

The Behavioral Health Case Manager (BHCM) is responsible for assessing a member’s behavioral health and developing a treatment plan to address the member’s mental health and/or substance use disorder needs. Serves as an active participant on the member’s Primary Care Team (PCT) and an advocate for the member. The BHCM is actively involved with the member from time of psychiatric admission through discharge and ensures all PCT members and healthcare providers are aware of member’s status. The BHCM facilitates prompt access to outpatient mental health supports, and community resources.

Responsibilities

Primary Job Responsibilites

 

Assessment and care plan coordination

 

  • Contacts Members and Caregivers/guardians telephonically and/or in person after receiving a BH referral to:
    •             Conduct behavioral health assessment(s) and administer other assessment tools as indicated;
    •             Assess and address the mental health needs of the members;
    •             Recommend modifications to the member’s integrated care plan.
  • Completes a home visit for all agreeable referred Members within alloted time frames and in the event of an emergent mental health need or as indicated behavioral health clinical change (not otherwise accounted for by a medical change) to assign a rating category which determines BH case management level of involvement.
  • Completes emergent home visits with Members to assess any reported suicidal/homicidal statements in conjunction with other members of the Care Team, plans emergent mental health supports utilizing Community Resources when appropriate and collaborates with Beacon Health Options for the admission of an Member to an inpt Psychiatric unit when indicated.
  • Completes home visits and follow up assessments after all BH hospitalizations/Transitions of Care
  • Coordinates care between multiple behavioral health and Primary Care Team providers as needed including but not limited to State Agencies. Identifies behavioral health services and care delivery settings and recommends alternatives when appropriate.
  • Offers proactive review of members for a multidisciplinary care planning with PCPs and PCTs.
  • Supports the PCTs in the development, implementation and modification of Individualized Care Plans for Members, attends PCT team meetings including those in provider offfices, community partner locations, office locations and otherwise.
  • Updates all relevant PCT team members regarding the Member’s mental health and substance use status and develops and/or proposes changes to the behavioral health care plan as appropriate.
  • Works collaboratively with the outreach team and Fallon ESR employees to assist in the smooth transition of potential Members who present with a defined behavioral health need including but not limited to: resources for medication compliance and appropriate in-network BH providers.

Clinical documentation and data management and reporting 

  • Documents outcomes of initial and follow up home visits in the CER per department guidelines ensuring all PCT members are notified of any emergent needs and data entry completed immediately.
  • Completes referrals for all the Member’s recommended behavioral health services, including outpatient supports, therapy, and medication management/assessment; ensures all PCT members and relevant caregivers are aware of referrals and goals. Documents all activity in the CER per department guidelines.
  • Completes/facilitates referrals for needed neuropsychiatric evaluation(s) notifying all PCT team members of evaluation referral and documenting referral activity in CER.
  • Monitors daily inpatient BH census log and contacts appropriate hospital staff to provide care coordination (as long as member has not restricted the facility to share information with Fallon). Within one business day ensures notification of Member’s psychiatric admission and forwards information to PCT team members for care coordination. Documents all activity in the CER per department guidelines.
  • Reviews all of the medications at initial and follow-up assessments with Members and forward results to the Nurse Case Manager or PCP as indicated. Documents all activity in the CER per department guidelines.
  • Initiates and updates Care Plan in the CER on all active members in the BHCM panel per Care Plan Process.

Monitors compliance

  • Strictly observes HIPAA regulations and Fallon Health’s policies regarding confidentiality of member information.
  • Strictly observes safety awareness and home visit process when conducting home visits.
  • Complies with all NaviCare reporting requirements and processes as applicable.
  • Ensures timely filing with the appropriate Protective Services agency regarding any concerns about the safety and well being of an Member.
  • Maintains an ongoing awareness of community clinical, psychiatric, and other outpatient resources as well as state and federal resources as needed.

 Provides training and consultation

 

  • Serves as a behavioral health consultant to the Fallon Health Clinical Integration Team
  • Works colaboratively with the Clinical Integration Geriatrician on clinical care issues.
  • Offers recommendations to continued program development and is an active participant in suggesting opportunities to enhance the program.      
  • Works with Fallon Health Provider Relations and Beacon Health Options to ensure that contracted behavioral health providers are knowledgable about the plan benefits, eligibility requirements, and care coordination and communication needs.
  • Coordinate with Beacon staff to ensure quality and timely arrangement of necessary mental health and substance use supports.
  • Attends Fallon Health/Beacon meetings when requested.
  • Attends supervision and 1:1 meetings with Manager. Attends Team Huddles, staff meetings, site meetings and other Fallon Health and business related meetings as required. Meetings may be in person or telephonic depending upon the need.
  • Attends and participates in team’s monthly medical rounds case presentations

 

Qualifications

Education

Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required.

 

License/Certifications

License: Active, unrestricted license as an LICSW and/or LMHC or license-eligible, current Driver’s license and a vehicle to be used for home visits

Certification: Certification in Case Management preferred

Other: Satisfactory Criminal Offender Record Information (CORI) results

 

Experience

A minimum of three years clinical experience in the behavioral health/mental health setting required. Experience with case management, especially substance use disorders and/or severe and persistent mental illness preferred.

Demonstrates proficiency including but not limited to:

  • Ability to conduct behavioral health assessments, develop and implement comprehensive care plans that addresses the member’s behavioral health needs in conjunction with their medical needs and social determinants of health
  • Ability to serve as a member on an interdisciplinary care team that may include the member’s primary care physician, medical providers, behavioral health providers, state agencies and/or internal nurse case managers and navigators
  • Ability to assist members with relevant food, housing and state applications (e.g. DDS, DMH)
  • Experience with subpopulations including children, adolescents, the homeless, and those with disabilities,
  • Effective case management, care coordination, and member advocacy skills
  • Knowledge about behavioral health 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
  • Familiarity with motivational interviewing and harm reduction to engage and connect with members
  • Knowledge of severe and persistent mental illness and substance use disorders
  • Ability to work collaboratively with BH vendor
  • Familiarity with software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word

 

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.

 

 

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Clinical Integration Nurse Case Manager

Fallon Health

Worcester, MA
10 days ago
Worcester, MA
10 days ago

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About NaviCare:

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.

 

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 structures 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.

 


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


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 & current Driver’s license and a vehicle to be used for home visits

Certification: Certification in Case Management strongly desired

Other: Satisfactory Criminal Offender Record Information (CORI) results

 

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

AND IF Working with the Fallon Health ACO Member Population:

  • 2+ years of clinical experience as a Registered Nurse working with people up to age 65 with a focus on working with people that are on MassHealth coverage and may be encountering social, economic, and/or multi complex medical and or behavioral health conditions required
  • IF focused to work with the pregnant member population, 4+ years of clinical experience as a Registered Nurse working with pregnant females during the prenatal, delivery, and postpartum time required
  • If focused to work with the Cancer Care Program member population, 4+ years of clinical experience as a Registered Nurse working with oncology, hospice, and/or chemo infusion required
  • Ability to communicate and collaborate with PCP, community and ACO partners to manage members care required
  • Experience working in a community social service agency, skilled home health care agency, State Agency such as the Department of Mental Health (DMH), Department of Developmental Services (DDS), Department of Children and Families (DCF), and/or the Department of Youth Services (DYS), or other agency servicing those in need 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:
    • Asks good questions
    • Critical thinking skills, looks beyond the obvious
    • Problem Solving
  • 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
    • Is able to write clearly and succinctly in a variety of communication settings and styles

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.

Posted

1 day ago

Description

Overview

Passionate about the Elderly? Looking for No Weekends/ No Holidays & Work/Life Balance? Interested in Case Management and stepping away from bedside care? Looking for Career Development?  Fallon's Nurse Case Manager is the position for you!

 

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About NaviCare:

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.

 

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 structures 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/Certifications

License: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits

Certification: Certification in Case Management strongly desired

Other: Satisfactory Criminal Offender Record Information (CORI) results

 

Experience

 

  • 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required

 

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.

Source: Fallon Health