Description
**Who We Are**
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here () .
**Job Summary**
The Care Manager - Nursing (RN CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works closely with the member, the caregiver/authorized representative, and providers to meet the targeted member-specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal wellness and improved self-management.
**Key** **Responsibilities/Duties** **- what you will be doing**
Administer assessments, collaborate with the member/caregiver and providers to develop a plan of care, implement member-specific CM interventions, and evaluate plan of care and revise as needed.
Facilitate program enrollment utilizing key motivational interviewing skills
Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member's care
Perform both telephonic and face to face outreach to assess barriers to wellness, medical, behavioral, and psychosocial needs of the member.
Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission
Performs case documentation in applicable CM system according to department and regulatory standards
Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i. e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and BH CM)
Attend and present (as appropriate), high risk members at interdisciplinary rounds forum
Maintain professional growth and development through self-directed learning activities
Other duties and projects as assigned.
**Qualifications - what you need to perform the job**
**COVID Policy**
Please note: We encourage all Point32Health colleagues to follow CDC guidance about COVID-19 vaccines, boosters, isolation and masking. Point32Health reserves the right to adjust its requirements in response to COVID-19 trends in the communities we serve.
**Education, Certification and Licensure**
Registered Nurse with current unrestricted license in state of residence
May be required to obtain other state licensure in states where Point32Health operates
Bachelor's Degree in Nursing preferred
National certification in Case Management desirable
**Experience** (minimum years required) **:**
5+ years' relevant clinical experience
Experience in home care or case management preferred
Proficiency in second language desirable
Experience in specialty areas such as oncology, neurology, chronic condition/disease management a plus
**Skill Requirements**
Skill and proficiency in technical concepts and principles; computer software applications
Skilled in assessment, planning, and managing member care
Advanced communication and interpersonal skills
Independent and autonomous with key job functions
Ability to address multiple complex issues
Flexibility and adaptability to changing healthcare environment
Ability to organize and prioritize work and member needs
Demonstration of strong clinical and critical thinking skills
**Working Conditions and Additional Requirements** (include special requirements, e. g., lifting, travel) **:**
Must be able to work under normal office conditions and work from remote office as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes
Valid Driver's license and vehicle in good working condition as some travel required
May be required to work additional hours beyond standard work schedule.
Other duties as assigned and needed by the department
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
**Compensation & Total Rewards Overview**
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit
**Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity**
Point32Health is committed to making diversity, equity, inclusion, accessibilit
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