SCO RN Care Manager - Boston Area

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.

Job Summary

Under the administrative direction of the Clinical Manager, the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to manage all aspects of member care for a panel of frail elderly, while working within a healthcare team. The NCM directly interfaces with physicians, other members of the primary care team, members, and their caregivers in identifying risk factors, conducting assessments, and developing and implementing care plans to comprehensively manage their members’ care.

Key Responsibilities/Duties – what you will be doing

The NCM will have a clear understanding of the role and will demonstrate a commitment to executing on the following responsibilities:

• Timely completion of initial and ongoing geriatric assessments

• Development and communication (with member, caregiver and primary care physician/primary care team) of an individualized plan of care

• Completion of the Minimum Data Set-Home Care (MDS-HC)

• Facilitation of member and caregiver access to community resources relevant to the member’s needs, including referrals to Adult Day Health, Adult Foster Care and the Personal Care Attendant Program. 

• Participation in routine primary care team meetings

• Pro-active management and follow-up (via home visits and by telephone) according to the member’s care plan

• Management and coordination of all transitions of care, including:
  • Communicating care plan to providers in all settings of care (ED, hospital, rehabilitation facility, nursing home, home care) and ensuring providers receive timely clinical data that may impact healthcare treatment decisions

• Direct caregiver support

• Serves as a member advocate and facilitator to resolve issues that may be barriers to care

• Provide education and coaching to the member, family, and/or caregiver about health status, treatment options, goals of care, and health insurance benefits to assist members in making the most informed decisions and help promote self-management

Qualifications – what you need to perform the job

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.

EDUCATION: (Minimum education & certifications required)

• Bachelors of Science in Nursing (BSN) and Registered Nurse with current, unrestricted state license is required. 

EXPERIENCE:  (Years of experience)

• Minimum 3 years clinical nursing experience required
• Experience in case management managing geriatric/chronic illness populations required
• Experience within a SCO program highly preferred
• Experience in Medicare and/or Medicaid managed care preferred
• Proficient in computer use, the Internet, and health information technology required
• Case management certification a plus

SKILL REQUIREMENTS: (Include interpersonal skills)

• Work cooperatively as a team member across multiple levels within the organization
• Demonstrate initiative in achieving individual, team, and organizational goals and objectives
• Must be able to prioritize work and develop strategies for adapting to constantly changing priorities and urgencies.
• Regard for confidential data and adherence to corporate compliance policy
• Demonstrate cultural competency and sensitivity
• Demonstrate the ability to work autonomously

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)

• Ability to travel frequently to member’s homes, hospitals, skilled nursing facilities, PCP office practices and other sites where patients receive care.

 

Compensation & Total Rewards Overview

Commitment 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.