RN Care Manager - Public Plans

"Who We ArePoint32Health 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 SummaryThe 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 goalsKey Responsibilities/Duties - what you will be doingPerform assessment and/or care management interventions for the referred and identified populationProvide 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 proceduresFacilitate 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 healthCommunicates with all providers, actively involved in the enrollee’s care, regarding individualized care plan progress, specific program participation, and complex case management interventionsMaintain goals and objectives of Tufts Health Plan in working with all enrollees for the coordination of services for the above enrollee populationWork 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 enrolleesContinuously assess the enrollee’s needs and updates the plan of care per established policies and proceduresAttend activities including clinical and other professional organization events as neededMaintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizationsMaintain an active Massachusetts profession-specific license in good standing without restrictionsOther duties as assignedQualifications - what you need to perform the jobCOVID PolicyPlease 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 LicensureRegistered Nurse with current unrestricted license in state of residence May be required to obtain other state licensure in states where Point32Health operatesBachelor’s Degree in Nursing preferredNational certification in Case Management desirableExperience (minimum years required):5+ years’ relevant clinical experienceExperience in home care or case management preferredProficiency in second language desirableExperience in specialty areas such as adult chronic conditionsPast Experience in Pediatrics or OB a plusSkill RequirementsSkill and proficiency in technical concepts and principles; computer software applicationsSkilled in assessment, planning, and managing member careAdvanced communication and interpersonal skillsIndependent and autonomous with key job functionsAbility to address multiple complex issuesFlexibility and adaptability to changing healthcare environmentAbility to organize and prioritize work and member needsDemonstration of strong clinical and critical thinking skillsWorking 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 outcomesValid Driver’s license and vehicle in good working condition as some travel requiredMay be required to work additional hours beyond standard work schedule.Other duties as assigned and needed by the departmentThe 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 OverviewAs 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 coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthFor more details on our total rewards programs, visit

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.PDN-9c1dce52-958a-48bd-a585-50de06d51f85"