Care Manager - Nursing (Field)

THPP Tufts Health Public Plans Inc; Massachusetts; Hybrid; USD 87,000 - 131,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health is hiring an OB Care Manager – Nursing Field (RN CM) to ensure pregnant members receive timely care management across the continuum, including transitions of care and disease management.

The role requires an RN with a current license and at least 5 years of clinical experience, preferably with home care or case management. Remote work may be required; travel and valid driver's license may be needed.

Qualifications

• Current unrestricted RN license in state of residence.
• Bachelor’s degree in nursing required; BSN preferred.
• Minimum 5 years of relevant clinical experience.
• National certification in Case Management desirable.
• Ability to work remotely as required since role supports field care management.

Responsibilities

• Perform telephonic member outreach and/or face-to-face encounters to facilitate program enrollment.
• Evaluate member needs and develop a member-specific plan of care with appropriate interventions.
• Complete documentation in applicable platform per policy and regulatory standards.
• Provide targeted health education and proactive strategies for condition management.
• Coordinate safe transitions to next level of care and ensure post-discharge follow-up.

Skills

Communication skills

Nursing assessment

Care coordination

Critical thinking

Documentation

Education

Bachelor's degree in nursing

RN licensure

Tools

Microsoft Office

Job description

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The OB Care Manager – Nursing Field (RN CM) will ensure that all pregnant 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 OB 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 maternal-fetal wellness and improved self-management.

Key Responsibilities/Duties – what you will be doing

• Perform telephonic member outreach and/or face‑to‑face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Through assessment and collaboration with member/caregiver and providers, develop a member‑specific plan of care, implement member‑specific care manager interventions, and revise plan of care as needed.
• Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• 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.
• 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 Behavioral Health CM).
• Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
• Maintain professional growth and development through self‑directed learning activities.

Qualifications – what you need to perform the job

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 Understand and follow the provisions of state‑specific Nurse Practice Act(s) where Point32Health operates National certification in Case Management desirable.

Education Required (minimum): Bachelor’s degree or relevant equivalent experience Preferred: Bachelor’s degree in nursing.

Experience Required (minimum): 5 years’ relevant clinical experience Preferred: Experience in home care or case management. Proficiency in a second language desirable. Experience in specialty areas a plus.

Skill Requirements Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications Work cooperatively as a team member across multiple levels within the organization 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 Regard for confidential data and adherence to corporate compliance policy.

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 travel is required May be required to work additional hours beyond standard work schedule. Other duties as assigned and needed by the department.

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.

Disclaimer

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.

Salary Range

$87,128.40 -$130,692.60

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. 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/

We welcome all All applicants are welcome and 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.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long‑standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.