Fallon Health RN Care Manager - Growing MLTC Program - Amherst NY in Amherst, NY, New York
Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high-quality, affordable health care.
Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all they serve. It consistently ranks as one of the nation's highest-rated health plans, according to the National Committee for Quality Assurance (NCQA).* Fallon Health coordinates care with its Senior Care Options/Special Needs Plan for dual-eligible people who are 65 and older. Fallon Health has operated a PACE program in Massachusetts for more than 20 years and is the largest PACE program in New England and sixth largest nationally.**
Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus.
The two parent companies, Fallon Health and Weinberg Campus, have demonstrated consistent commitment to providing an array of solutions that make high-quality, integrated and affordable care more accessible to the poor, disabled and senior populations within the communities they serve.
Fallon Health Weinberg in Amherst, NY is currently seeking an experienced RN Nurse Care Manager for our quickly expanding MLTC program. This is a full time day, Monday - Friday, RN nursing position. At Fallon Health Weinberg, you’ll find a competitive salary, comprehensive benefits and a stimulating, collaborative culture. Our dedicated professionals truly work as a TEAM, united by compassion for the people we support, each contributing to our innovative approach to health care.
Fallon Health Weinberg is increasing access to high-quality, person-centered, cost-effective health care programs for older individuals who require supportive services due to long-term health needs but want to remain living independently in the Buffalo NY community.
We currently offer three plans to provide care and care coordination for people in their homes:
Managed Long Term Care Plan (MLTC)
PACE: Program of All Inclusive Care for the Elderly.
Under the direction of the Director of Clinical Services (DCS), the FHW Care Manager (CM) is able to work both independently and collaboratively with other members of the FHW Program Primary Care Team. The CM follows established departmental policies and standards for timely completion of assigned work. Problems lacking clear precedent are reviewed with DCS or her/his designee prior to taking action. The CM presents a clear definition of problem(s) when reviewing with the Primary Care Team, Primary Care Physician and/or Medical Director.
The FHW Care Manager (CM) assesses a Members clinical/functional status and develops a plan to coordinate a continuum of care consistent with the Members health care needs and/or goals. The Individualized Care Plan (ICP) supports the Member attaining and/or maintaining an optimal functional status. The CM is an active participant in the Members Interdisciplinary Care Team (ICT) and is an advocate for the Member.
The CM is actively involved with the Member at times of care transition, including but not limited to planned and unplanned admissions, and works in conjunction with the members team to ensure care plan communication between all providers and members of the ICT.
The CM coordinates care between multiple medical and Primary Care Team Providers. The CM is able to identify services, care delivery settings, and recommends alternatives where appropriate.
The CM monitors the care and provides consistent feedback to team on progress. The CM collaborates and works with all members of the Interdisciplinary Care Team and, when appropriate, the FHW care manager will work with Acute care hospitals, rehab facilities and skilled nursing facilities to ensure an effective care plan to meet member care needs. The CM may attend Facility Discharge Planning Rounds and works to ensure a smooth discharge and transition as appropriate
Reviews Member enrollment data, claims data, urgent and emergency room utilization, acute/skilled nursing inpatient census, referrals from Interdisciplinary Care Team (ICT) and vendors, and other appropriate data prior to initiating any Member contact
Contacts Members/caregivers telephonically and/or in person to at time of enrollment, at time of care transition, and/or ongoing based upon Program requirements to:
Perform a health needs assessment
Assess the health needs of the Members and/or
Recommend modifications to care plan elements
Completes a home visit/facility visit for all assigned Members as necessary, ideally within the first 60 days of members enrollment, any time there is a clinical change, or at intervals defined by FHW in order to determine member’s current needs.
Is a member of the assigned members ICT and attends all meetings.
Works closely with the Member’s team to initiate ICT meetings with ICT members/Members/caregivers as necessary and ensures the participation of appropriate interdisciplinary team members
As a member of the ICT, updates all relevant team members regarding the Member’s status and develops/proposes changes to the care plan
Identifies, aligns, and utilizes health plan and community resources that impact high-risk/high cost care
Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the Member attains pre-determined outcomes
Streamlines 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
Works collaboratively and cohesively with all members of the Primary Care
Utilizes a successful communication style and methods to engage Member’s in care management – does not ‘easily give up’ and works to engage Member’s as appropriate
Identifies and shares best practices and innovative care management strategies with the team
Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/Designee
Strictly observes HIPPA regulations and the FHW policies regarding confidentiality of member information
Performs other responsibilities as assigned by the Supervisor/designee
Other tasks as identified
Lifting requirements—Less than 50 pounds
Ergonomic requirements—Large amount of time seated viewing computer
Education: Graduate from an accredited school of nursing orMaster’s Degree in social work required
License: Active, unrestricted license as a Registered Nurse in New York state
Certification: Certification in Case Management desired, encouraged upon hire
A minimum of three to five years clinical experience as a Registered Nurse or social worker working with the chronically ill, geriatric patients.
Minimum 2 years of experience in Home Health care setting working with Medicare/Medicaid required having demonstrated care coordination, accessing community resources a plus.
Experience working with patients/members in Long term care setting a plus.
Experience as a care manager within a payer setting with demonstrated ability to case manage a plus.
Additional Performance Requirements:
Demonstrated favorable (verbal and written) communication and organizational skills.
Demonstrated favorable interpersonal and assessment skills.
Ability to meet established productivity goals.
Ability to identify patterns, connections and underlying themes that lead to understanding and resolving complex problems or situations.
Ability to focus on specific disease processes/health issues and identify strategies to promote client focused care planning
Familiarity with provisions of governmental and accrediting agency health plan requirements.
Familiar with applying clinical criteria when determining medical necessity and/or benefit administration.
Computer literacy required.
Job ID 5752
# Positions 1
Category Case Management