Nurse Care Manager
2 weeks ago
The Care Manager RN will ensure that all 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 per department guidelines.
Key Responsibilities- Perform assessment and/or care management interventions for the referred and identified population
- 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
- 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
- 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 management interventions
- Perform in-person outreach visits in assigned geographic region and throughout the state as necessary for purposes of engagement and enhanced care coordination with enrollees, providers, and other collateral supports
- Maintain goals and objectives of Tufts Health Plan in working with all enrollees for the coordination of services for the above enrollee population
- Work 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 enrollees
- Continuously assess the enrollee's needs and updates the plan of care per established policies and procedures
- Attend activities including clinical and other professional organization events as needed
- Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations
- Registered Nurse with current unrestricted license in state of residence
- May be required to obtain other state licensure in states where Point32Health operates
- Bachelor's Degree in Nursing preferred
- National certification in Case Management desirable
- 5+ years' relevant clinical experience
- Experience in home care or case management preferred
- Proficiency in second language desirable
- Experience in specialty areas such as oncology, neurology, chronic condition/disease management a plus
The nurse care manager will work in a hybrid environment, visiting facilities in the Worcester area and working remotely out of a home office.
BenefitsPoint32Health offers a comprehensive total rewards package, including medical, dental and vision coverage, retirement plans, paid time off, employer-paid life and disability insurance, tuition program, well-being benefits, and a full suite of benefits to support career development, individual & family health, and financial health.
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