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Fallon Health SE Primary Nurse in Springfield, Massachusetts


About Fallon Health:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter, and LinkedIn.

About Summit ElderCare :

Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.

Brief Summary of Position:

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice.


Job Responsibilities:

  • Primary nurse not only has the responsibility for the participant, but the authority to advocate for the best care for the participant unique to their situation.

  • Fostering a relationship with the caregiver and participant.

  • Primary Nurse will take on a Leadership Role.

  • Effectively communicate with the healthcare team.

  • Assigns tasks and duties to the healthcare team; ensure the tasks are completed; responsible for their panel.

  • Develops an individualized plan of care.

  • Accountability for assessments, communicating needs and coordinating the care team.

  • Primary nurse develops the plan of care

  • Reviews and implements Provider’s orders.

  • Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and MDS-HC as indicated.

  • Involves participants and significant other(s) based on needs and abilities.

  • Delivers care to participants in any setting, including skilled services, based on individualized needs and according to age-appropriate nursing standards.

  • Provides for cultural and diverse needs of participants when providing care.

  • Monitors and evaluates therapeutic interventions.

  • Delegates and or accepts participants’ care responsibilities to other members of the health care team, when appropriate.

  • Identifies emergency situations and initiates appropriate nursing orders/interventions.

  • Meets the needs of participants in a timely manner.

  • Participates in the interdisciplinary team (IDT) process and collaborates with IDT members to meet the needs of participants

  • Consistently documents all aspects of participant care, including significant changes in health status, monthly nurses’ notes and health care teaching in the medical record.

  • Participates in training and orientation of new nursing staff as assigned.

  • Assists in the delivery of other nursing services as assigned.

  • Participates in the nursing “on-call” rotation as assigned.

  • Initiates and completes falls, infection, grievance and incident reports

  • Participates in CMS calls when deemed necessary.

  • Active participant in the site specific committees.

  • Participates in the post IDT huddle and any other additional meetings

  • Any additional tasks deemed necessary by the Clinical Nurse Manager and or Site Director.

  • Assumes the role of the home care nurse, floor or triage nurse per the direction of the Clinical Nurse Manager or Site Director as appropriate.

  • Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures.

  • Functions independently to administer medications and treatments as ordered by the provider. Functions independently in the primary nurse role. Independent in performing a nursing assessment and executing the plan of care in all settings the participant maybe in.

  • Medication administration

  • Performing bladder scans, EKG, Point of Care, and glucometer testing



Graduate of an accredited school of nursing


Current license as an RN in the state of Massachusetts


CPR and Alzheimer’s certification, or willingness to be certified within 60 days of hire, is essential. *   *


  • At least two years of recent experience in the direct care of adults or chronically disabled persons with at least one year caring for a frail or elderly population. * *

  • Ambulatory care or home care experience helpful.

  • Ability to use an electronic medical record.

*Other:  *

Reliable Transportation Required 

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


Location US-MA-Springfield

Posted Date 1 month ago (3/3/2023 2:18 PM)

Job ID 7129

# Positions 1

Category Nursing