SCO South Quincy/Randolph Area

Point32Health • Canton, MA

5d • $87,174 - $130,761

About The Position

The Care Manager – Nursing Field (RN CM) ensures members receive timely care management across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management in accordance with department guidelines. The nurse care manager applies clinical knowledge and critical thinking to facilitate care plans that support quality medical care and member-specific goals.

The RN CM works with members, caregivers or authorized representatives, and providers to support optimal wellness and improved self-management. Based on national standards for care management practice, the position includes member outreach, holistic assessment, care planning, education, coordination of services, and collaboration with an interdisciplinary care team. The role may involve work under normal office conditions or from a remote office, as well as travel for face-to-face visits with members, providers, or facilities.

Requirements

• Current unrestricted Registered Nurse license in state of residence.
• May be required to obtain licensure in other states where Point32Health operates.
• Understand and follow the provisions of applicable state Nurse Practice Acts.
• Bachelor’s degree or relevant equivalent experience.
• At least 5 years of relevant clinical experience.
• Proficiency with Microsoft applications, technical concepts and principles, and computer software applications.
• Ability to work cooperatively as a team member across multiple organizational levels.
• Skill in assessing, planning, and managing member care.
• Advanced communication and interpersonal skills.
• Ability to perform key job functions independently and autonomously.
• Ability to address multiple complex issues.
• Flexibility and adaptability in a changing healthcare environment.
• Ability to organize and prioritize work and member needs.
• Strong clinical and critical-thinking skills.
• Ability to protect confidential data and adhere to corporate compliance policy.
• Ability to work under normal office conditions and from a remote office as required.
• Ability to use a telephone/headset and PC/keyboard simultaneously and sit for extended durations.
• Ability to make face-to-face visits to member homes, provider practices, and facilities as needed.
• Valid driver’s license and a vehicle in good working condition; travel is required.
• May be required to work additional hours beyond the standard work schedule.

Nice To Haves

• National certification in Case Management is desirable.
• Bachelor’s degree in nursing preferred.
• Experience in home care or case management preferred.
• Proficiency in a second language is desirable.
• Experience in specialty areas is a plus.

Responsibilities

• Perform telephonic outreach and/or face-to-face encounters using motivational interviewing to facilitate program enrollment.
• Conduct departmental assessments and holistically evaluate members to identify needs, health goals, and barriers to wellness.
• Develop member-specific plans of care in collaboration with members, caregivers, and providers; implement interventions and revise plans as needed.
• Document work in the applicable platform in accordance with departmental policy and regulatory standards.
• Provide targeted health education, proactive condition-management strategies, and communication with providers and vendors involved in members’ care.
• Coordinate safe transitions to the next level of care with members, caregivers, and facility care teams, including supporting understanding of discharge instructions, arranging services and follow-up, and implementing strategies to prevent readmission.
• Collaborate and liaise with interdisciplinary care team members, including Utilization Management, the Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM.
• Attend and present high-risk members at interdisciplinary rounds, as appropriate.
• Maintain professional growth and development through self-directed learning activities.
• Perform other duties as assigned and needed by the department.

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.
• Benefits supporting career development, individual and family health, and financial health.
• Colleagues are eligible for variable pay; eligibility for bonuses, commissions, benefits, or other compensation is at the company’s discretion.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level