[Hiring] RN Care Manager - Senior Care Options - Central Boston Elder Services Area - Bilingual preferred (Spanish) @Point32Health

Role Description

The Care Manager – Nursing Field (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
• Disease/chronic condition management per department guidelines

The nurse care manager possesses strong clinical knowledge, critical thinking skills, and the 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.

Key Responsibilities/Duties

• Perform telephonic member outreach and/or face-to-face encounters utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed through assessment and collaboration with member/caregiver and providers.
• Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, ensuring understanding of post-hospital discharge instructions, facilitating needed services and follow-up, and implementing strategies to prevent re-admission.
• Collaborate and liaise with the interdisciplinary care team to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM).
• Attend and present (as appropriate) high-risk members at interdisciplinary rounds forum.
• Maintain professional growth and development through self-directed learning activities.

Qualifications

• Registered Nurse with current unrestricted license in state of residence.
• May be required to obtain other state licensure in states where Point32Health operates.
• Understand and follow the provisions of state-specific Nurse Practice Act(s) where Point32Health operates.
• National certification in Case Management desirable.
• Required (minimum): Bachelor’s degree or relevant equivalent experience.
• Preferred: Bachelor’s degree in nursing.
• Required (minimum): 5 years’ relevant clinical experience.
• Preferred: Experience in home care or case management.
• Proficiency in a second language desirable.
• Experience in specialty areas a plus.

Requirements

• Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications.
• Work cooperatively as a team member across multiple levels within the organization.
• Skilled in assessment, planning, and managing member care.
• Advanced communication and interpersonal skills.
• Independent and autonomous with key job functions.
• Ability to address multiple complex issues.
• Flexibility and adaptability to changing healthcare environment.
• Ability to organize and prioritize work and member needs.
• Demonstration of strong clinical and critical thinking skills.
• Regard for confidential data and adherence to corporate compliance policy.

Working Conditions and Additional Requirements

• Must be able to work under normal office conditions and work from remote office as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• Ability to make face-to-face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes.
• Valid Driver’s license and vehicle in good working condition as travel is required.
• May be required to work additional hours beyond standard work schedule.
• 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.
• Full suite of benefits to support career development, individual & family health, and financial health.

Salary Range

$87,137.85 - $130,706.77