AV
AvoltaShift Manager
Manager I at HMSHost supervising restaurant management operations and ensuring compliance with operational standards. Overseeing team activities and maintaining high levels of service at the airport food & beverage location.
About the role
- 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
Requirements
- Graduate from an accredited school of nursing mandatory
- Bachelors (or advanced) degree in nursing or a health care related field preferred
- Active, unrestricted license as a Registered Nurse in Massachusetts
- Certification in Case Management strongly desired
- Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation
- 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
- 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
- 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
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
AV
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