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Who We Are

Point32Health 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{rel="nofollow" https:="" youtu.be="" s5i_hgoecjq="" ""="" target="" _blank""=""}.

Job Summary

The 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. This is a hybrid position that will visit facilities in the Worcester area and work remotely out of a home office. 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 goals.

Key Responsibilities/Duties -- what you will be doing

Job Description

• Perform assessment and/or care management interventions for the referred and identified population
• Ability to travel frequently to member's homes, hospitals, PCP office practices and other sites where patients receive care

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``` - Provide 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 procedures

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``` - Facilitate 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 health

Communicates with all providers, actively involved in the enrollee's care, regarding individualized care plan progress, specific program participation, and complex case manag