SCO South Quincy/Randolph Area

Point32Health • Canton, MA

4d

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 and chronic-condition management. The role uses clinical knowledge and critical thinking to facilitate care plans that support quality medical care and member-specific goals.

The RN CM works closely with members, caregivers or authorized representatives, and providers. Using national standards for care management, the position empowers members to support optimal wellness and improved self-management. The role includes telephonic outreach and face-to-face visits as needed, and requires travel to member homes, provider practices, and facilities.

Requirements

• Current, unrestricted Registered Nurse license in the state of residence.
• Must understand and follow applicable state-specific Nurse Practice Acts; may be required to obtain licensure in other states where Point32Health operates.
• At least 5 years of relevant clinical experience.
• Bachelor’s degree or relevant equivalent experience.
• Skill and proficiency in Microsoft applications, technical concepts and principles, and computer software applications.
• Ability to work cooperatively across multiple organizational levels and as a team member.
• Skills in assessment, 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 and adapt to a changing healthcare environment.
• Ability to organize and prioritize work and member needs.
• Strong clinical and critical-thinking skills.
• Regard for confidential data and adherence 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.
• Bachelor’s degree in nursing.
• Experience in home care or case management.
• Proficiency in a second language.
• Experience in specialty areas.

Responsibilities

• Perform telephonic member outreach and/or face-to-face encounters, using motivational interviewing skills to facilitate program enrollment.
• Complete departmental assessments and evaluate members holistically to identify needs, health goals, and barriers to wellness.
• Develop member-specific plans of care through assessment and collaboration with members, caregivers, and providers; implement interventions and revise plans as needed.
• Complete documentation in applicable platforms according to departmental policy and regulatory standards.
• Provide targeted health education and proactive condition-management strategies, and communicate with providers and vendors involved in members’ care.
• Collaborate with members, caregivers, and facility care teams to coordinate safe transitions to the next level of care, including post-discharge instruction review, arranging services and follow-up, and preventing readmission.
• Collaborate and liaise with the interdisciplinary care team, 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 coverage
• Dental coverage
• 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
• Eligibility for variable pay

What This Job Offers

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