Rn Care Manager - Public Plans

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.The nurse Care Manager will ensure that Tufts Health Plan enrollees receive timely care management across the continuum of care including complex case management, transitions of care, care coordination, population health and wellness interventions, and disease management per guidelines as established by the Integrated Care Management team at Tufts Health Plan. This position will be responsible for implementation and coordination of care management interventions across the continuum for identified enrollees, both in a specific program or simply in need of more intensive, long-term services than provided in episodic case management. The Care Manager will work closely with the enrollee, family/authorized representative and providers to develop an enrollee specific care plan to meet the targeted goals

Key Responsibilities/Duties – what you will be doing

• Perform assessment and/or care management interventions for the referred and identified population

• Provide targeted health education to the enrollee, and their family members/caregivers about available benefits, community resources, health care alternatives, and the importance of proactive disease and/or condition management approaches healthcare and wellness.
• Assist clinical disease management team with establishing and maintaining efficient and effective communication processes with vendors providing home interventions for Tufts Health Plan membership.
• Complies with departmental workflow and documentation policies and procedures

• Facilitate communication between the Care Manager and the enrollee and the enrollee with their practitioners to promote empowering the enrollee to take an active role in managing their health

• Communicates with all providers, actively involved in the enrollee’s care, regarding individualized care plan progress, specific program participation, and complex case management interventions

• Maintain goals and objectives of Tufts Health Plan in working with all enrollees for the coordination of services for the above enrollee population

• Work in close collaboration between the behavioral health Care Managers, social Care Managers, and other department and division-wide colleagues to provide integrated care for at-risk enrollees

• Continuously assess the enrollee’s needs and updates the plan of care per established policies and procedures

• Attend activities including clinical and other professional organization events as needed

• Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations

• Maintain an active Massachusetts profession-specific license in good standing without restrictions
• Other duties 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 adult chronic conditions
• Past Experience in Pediatrics or OB 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 https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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