RN Case Manager – SCO Program

Fallon Health

. Assess and manage a member panel through in-person and telephonic outreach .

Posted 11/4/2026full-timeFall River • Massachusetts • United StatesJunior💰 $95,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care management, including conducting assessments, developing individualized care plans, and coordinating services in compliance with regulatory standards. Strong communication and problem-solving skills are essential for effective collaboration with interdisciplinary teams and supporting member self-management.

Highest-signal resume keywords

Registered Nurse LicenseCase Management CertificationClinical RN ExperienceMedication ReconciliationInterdisciplinary Team Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care Transition AssessmentMedication ReconciliationIndividualized Care PlansAssessments and ScreeningsTelehealth AssessmentsKnowledge of Regulatory RequirementsSocial Determinants of Health ScreeningHEDIS InitiativesQuality Improvement InitiativesCare Planning Activities

Soft Skills

Strong Communication SkillsProblem-Solving SkillsAdaptabilityInterviewing SkillsCoaching Skills

Certifications & Qualifications

Registered Nurse LicenseCase Management Certification

Industry Keywords

Home HealthMedicareMedicaidOASISMDSHIPAA ComplianceCare CoordinationCulturally Appropriate CareMember OutreachBehavioral Health

About the role

Key responsibilities & impact

Assess and manage a member panel through in-person and telephonic outreach
Complete medication reconciliations and care transition assessments
Educate members on benefits, rights, disease management, medications, and preventive screenings
Ensure members and authorized representatives participate in and approve care plans
Support member self-management through coaching and health education
Develop and update individualized care plans based on assessments
Coordinate services and authorize care according to program and regulatory standards
Collaborate with Navigators, PCPs, Behavioral Health Case Managers, pharmacists, and community partners
Track progress toward goals and adjust care plans as needed
Participate in interdisciplinary rounds and team communication
Build relationships with members, caregivers, and providers for coordinated, culturally appropriate care
Complete assessments, screenings, notes, and care plans within regulatory timelines
Follow HIPAA and organizational confidentiality policies
Support HEDIS, Medicare 5-Star, and quality initiatives through outreach and education
Assist with departmental campaigns, projects, and coverage as assigned
Conduct in-house face-to-face visits and telephonic care transitions for members requiring additional interaction
Create initial care plans, update care plans, and execute care-planning activities for medically complex members
Collaborate with Navigators to address medical concerns and provide holistic case management

Requirements

What you’ll need

Graduate from an accredited school of nursing
Associate’s degree required; bachelor’s or higher preferred
Active, unrestricted license as a Registered Nurse in Massachusetts
Certification in Case Management strongly desired; willingness to obtain when eligible
Valid driver’s license
No disqualifiers per Driver Safety Policy
Proof of minimal state-required auto insurance
Reliable transportation
1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities
Ability to conduct assessments in-person and telehealth
Ability to work on interdisciplinary teams
Skill in screening social determinants of health
Strong communication and interviewing skills
Problem-solving skills and adaptability
Knowledge or willingness to learn regulatory requirements
Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions
Reliable home internet

Benefits

Comp & perks

Care coordination and case management professional experience
Reliable home internet required for hybrid work
Personal motor vehicle use supported by required auto insurance and reliable transportation