Wellness Nurse Case Manager
Company: Family Service Association - Fall River
Location: Fall River
Posted on: May 5, 2022
Job Description:
Job DescriptionWellness Nurse Case Manager Family Service
Association is a comprehensive private, non-profit social service
agency dedicated to the development and implementation of services
designed to provide strength and support to individuals and
families throughout southeastern Massachusetts. Headquartered in
Fall River, Family Service Association strives to increase the
capacity of individuals and families to cope with the stresses of
family life and interpersonal relationships in a positive,
productive and health-improving manner. This agency is a leading
provider of professional social services in the South Coast region
of Massachusetts, with a 130-year tradition of high quality.**Sign
on Bonus $2,000**We have an exciting opportunity in a new program
initiative at Family Service Association. We are seeking a full
time (35 hours per week), Monday through Friday, 9:00 a.m. - 5:00
p.m., Wellness Nurse Case Manager in our Long-Term Support Service
Community Program (LTSS CP). The Long Term Services and Supports
(LTSS) Community Partners (CP) Care Integration and Wellness Nurse
Case Manager is responsible for assisting the Care Coordination
teams to enhance coordination in the delivery and receipt of
services to enrollees assigned by Accountable Care Organizations
(ACO) and Managed Care Organizations (MCO), or Mass Health. Duties
and Responsibilities:
- Respect the confidential nature of all program services and
communications therewith.
- Assist with enhancing program's ability to capture demographic
information, interpret all data, including gaps in care, to
determine where disparities exist in order to address them.
- Provide consultation and support care coordination teams whose
assigned members have identified wellness goals to discover and
break-down barriers to positive health outcomes.
- Assist Care Coordinators with developing care plan goals that
address health disparities.
- Provide training and support to Care Coordinators to enhance
their ability to support the wellness goals of their members,
including strengthening of health and wellness coaching, use of
SBAR, understanding risk factors, etc.
- Provide case consultation and / or attendance at Integrated
Case Conferences for members with complex medical and / or SDOH
needs.
- Assist with transitions of care for members with complex health
needs, including but not limited to, being lead point of contact to
assure integrated care between ACO / MCO, PCP, CP staff, providers
and other team members.
- Provide outreach to hospital or emergency departments to
develop relationships in order to facilitate gathering of
information, including discharge summaries, and create glide paths
for transitions of care, and continued integration.
- Maintain all documentation required for the delivery of LTSS
Community Partners services including other data entry into EHR as
required.
- Attend regular supervisory meetings both on a team and
individual basis as required
- Participation in on-going CQI activities.
- Respond to reasonable expectations of the Agency and/or
supervisor. ***Family Service Association is offering a $2,000
Signing Bonus ***Education and Experience: Must be a Registered
Nurse with current license for the state of Massachusetts in good
standing as well as possess experience in dealing with youth and
adults, individuals with complex medical needs, and disabled
populations. This is a benefits eligible position. Benefits include
medical, dental, vision, long term disability insurance, life
insurance, 403(b), flexible spending account and a generous time
off package including paid vacation, ten sick days accrued annually
with rollover and twelve paid holidays. We offer ongoing training
opportunities and an excellent work environment. Powered by
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Keywords: Family Service Association - Fall River, Fall River , Wellness Nurse Case Manager, Healthcare , Fall River, Massachusetts
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