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Fallon Health Nurse Case Manager - New Role ACO - Multiple openings - Tell a Friend - Growing Healthcare Organization in Worcester, Massachusetts


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.

Calling all RN Nurse Case Managers! It’s a very exciting time to join Fallon Health in these brand new roles supporting our growth in our MassHealth ACO (Accountable Care Organization) partnerships!

We have many needs so bring along your RN friends and colleagues !

In 2018, 18 health care organizations across the state were selected to participate in MassHealth’s ACO program. This involves networks of physicians, hospitals and other health care providers working together with managed care organizations to provide integrated health care for their patients with the goals of improving their health and containing costs. Fallon Health was awarded 3 key ACO partnerships and things are going great! So great we looking to grow our workforce to support this successful initiative. Some of the Nursing talent we’re looking for include Nursing Specialties in any of the following (but not limited to):

Behavioral Health, Obstetrics, Labor and Delivery, NICU, Oncology, Hospice, Palliative Care, Elder Care, Traumatic Brain Injury, Nursing Home Care, SNFs, State Agency, Hospital Case Management and more.

It’s predominantly telephonic care BUT – it’s a standard 8-5 type of day with no evening or weekend shifts. You’re also not on call and won’t be asked to work holidays!

Come help us build this ACO business, change the way health care is delivered to Medicaid members and use your creatively and problem solving skills!

The Nurse Case Manager (NCM) Internal is focused on care coordination and improving quality of care and access to services for Fallon members. The NCM Internal supports the Clinical Integration Team in a role that does not routinely complete in-home/facility face-to-face visits with members and/or providers. Responsibilities include telephonically assessing a Members clinical/functional status to identify ongoing special conditions and providing education. Develops and implements an individualized, coordinated care plan in collaboration with the member and Primary Care Provider and/or specialist and other community partners to ensure quality outcomes in a cost effective way. Communicates with member/family/caregiver(s) in accordance with frequency of Case Management contact guidelines. Works collaboratively with other members of the Clinical Integration Team to provide overall case management, care plan oversight, and care coordination for our members

* This role is based in Worcester MA*


  • Excellent communication and interpersonal skills with members and providers via telephone

  • 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

  • Demonstrates commitment to the Fallon Health Mission, Values, and Vision

  • Specific competencies essential to this position:

  • Problem solving

  • Asks good questions

  • Critical thinking skills, looks beyond the obviou

  • 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


Graduate from an accredited school of Nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field

L icense: 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


Job ID 5728

# Positions 1

Category Nursing