RN Care Manager Boston

TAHMO Tufts Associated HMO Inc; Canton (MA); Hybrid; USD 87,000 - 131,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health is seeking a Care Manager – Nursing Field (RN CM) to ensure timely care management across the continuum, including transitions of care, care coordination, and disease management. The RN CM collaborates with members, caregivers, and providers to empower optimal wellness and self-management.

The role requires an unrestricted RN license, a Bachelor’s degree, and at least 5 years of clinical experience.

Qualifications

• RN with current unrestricted license in state of residence; other state licensure may be required where Point32Health operates
• Bachelor’s degree or relevant equivalent experience required
• National certification in Case Management desirable
• Minimum 5 years of relevant clinical experience
• Preferred: home care or case management experience
• Proficiency in a second language is desirable

Responsibilities

• Perform telephonic member outreach or face-to-face encounters to facilitate program enrollment
• Assess member health goals and barriers to wellness to tailor care plans
• Develop and implement member-specific care plans and revise as needed
• Document in applicable platform per policy and regulatory standards
• Provide targeted health education and proactive strategies for condition management
• Coordinate safe transitions to higher levels of care and arrange follow-up services
• Collaborate with multidisciplinary care team to improve member outcomes and participate in rounds

Skills

Communication skills

Care planning

Autonomy

Problem solving

Microsoft Office

Prioritization

Adaptability

Critical thinking

Education

Registered Nurse license

Bachelor’s degree

Case management certification

Tools

EHR systems

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 Care Manager – Nursing Field (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.

Job Description

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

$87,091.58 -$130,637.38

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.

Benefits

• 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/

Equal Opportunity / Diversity / Inclusion Statement

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.