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Insurance Assessment Nurse Jobs (NOW HIRING)

95149

Community Assessment Nurse (RN)

Leominster, MA · On-site

$34 - $37/hr

Health, dental, and vision insurance * Retirement plan with employer contribution * Generous paid time off * Paid holidays * Employee Assistance Program * Ongoing professional development

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Insurance Assessment Nurse information

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How much do insurance assessment nurse jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for insurance assessment nurse in the United States is $44.36, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.56 per hour, depending on experience, location, and employer.

What does an insurance assessment nurse do?

An Insurance Assessment Nurse is a registered nurse who evaluates patients' medical conditions to determine eligibility for insurance coverage, claims, or benefits. They review medical records, assess health status, and may conduct interviews with patients or healthcare providers. Their assessments help insurance companies make informed decisions about policy approvals, claims, and coverage levels. These nurses play a crucial role in ensuring that clients receive appropriate benefits according to their medical needs and insurance policies.

How does an insurance assessment nurse typically collaborate with other professionals in the claims process?

Insurance Assessment Nurses often work closely with claims adjusters, underwriters, and medical directors to evaluate the medical aspects of insurance claims. They review medical records, conduct interviews with claimants, and may consult with treating physicians to gather comprehensive information. This collaborative approach ensures that claims decisions are well-informed and align with both medical standards and company policies. Effective communication and teamwork are essential in this role, as accurate assessments directly impact claim outcomes.

What are the key skills and qualifications needed to thrive as an insurance assessment nurse, and why are they important?

To thrive as an Insurance Assessment Nurse, you need a current RN license, strong clinical assessment skills, and experience with medical record review. Familiarity with insurance guidelines, claims systems, and utilization review software such as InterQual or MCG is typically required. Attention to detail, critical thinking, and effective communication help nurses accurately evaluate cases and collaborate with clients or adjusters. These skills are crucial for making informed coverage decisions, ensuring compliance, and supporting fair and timely claims processing.

What is the difference between Insurance Assessment Nurse vs Case Manager Nurse?

AspectInsurance Assessment NurseCase Manager Nurse
CredentialsRN license, possibly certifications in case management or insuranceRN license, case management certification often preferred
Work EnvironmentInsurance companies, telehealth, or remote assessmentsHospitals, clinics, or community health settings
Employer & IndustryInsurance providers, third-party administratorsHealthcare facilities, insurance companies, community agencies
Primary FocusEvaluating medical claims, determining coverage, assessing health status for insurance purposesCoordinating patient care, managing treatment plans, ensuring healthcare needs are met

While both roles require nursing credentials and involve healthcare assessments, the Insurance Assessment Nurse primarily focuses on evaluating medical claims and insurance coverage, often working remotely. In contrast, the Case Manager Nurse manages patient care plans within healthcare settings. Understanding these differences helps job seekers identify the right career path in the insurance and healthcare industries.

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Insurance Assessment Nurse jobs near you
Infographic showing various Insurance Assessment Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $92,274 per year, or $44.4 per hour.

SCO Assessment Nurse Case Manager - Lowell

Lowell, MA • On-site

Fallon Community Health Plan, Inc.
Outpatient Health Care • 1 - 5K employees
Learn more about Fallon Community Health Plan, Inc.external

$95K - $100K/yr

Other

Posted 10 days ago

Job description

Overview About us:

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 Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. 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.

Brief summary of purpose:

The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and completes regulatory assessments. The Assessment Nurse Case Manager completes in person Health Risk Assessments (HRAs) in accordance with members assigned frequency. The Assessment Nurse Case Manager completes all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool and well as yearly PCA reevaluations. The Assessment Nurse Case Manager is also responsible for the timely and accurate submission of yearly (and when there is a significant change in status) MDS assessments. Assessments are done primarily in person but may at times be completed telephonically.

Responsibilities Overview

  • Conducts home visits for onboarding and regulatory assessments.

  • Completes HRAs and PCA assessments.

  • Submits MDS assessments.

  • Provides education on NaviCare case management program.

  • Conducts telephonic assessments when appropriate.

  • Collaborates with Care Team.

  • Completes LTSS evaluations and collaborates with UM.

Member Assessment, Education & Advocacy

  • Conducts in-home assessments with motivational and culturally sensitive interviewing.

  • Performs medication reconciliation.

  • Completes State-required assessment tools per contract.

  • Conducts functional assessments for LTSS programs.

  • Participates in training and audits.

  • Completes telephonic/virtual assessments.

  • Maintains program/policy knowledge to educate members.

  • Supports HEDIS, Medicare 5 Star, and other initiatives.

Qualifications Education:

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

License:

Active, unrestricted license as a Registered Nurse in Massachusetts

Certification:

Certification in Case Management strongly desired

Other:

Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

  • Must possess a valid drivers’ license

  • Must attest to no disqualifiers per Driver Safety Policy

  • Must possess and provide proof of minimal state required auto insurance

  • Must have reliable transportation

Experience:

  • 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.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

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.

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Location US-MA-Lowell

Posted Date 5 days ago (8/31/2026 1:43 PM)

Job ID 8449

Positions 1

Category Nursing

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