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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, clickhere{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.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

• Perform assessment and/or care management interventions for the referred and identified population

{=html} <!-- --> - 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

{=html} <!-- --> - 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

{=html} <!-- --> - Communicates with all providers, actively involved in the enrollees care, regarding individualized care plan progress, specific program participation, and complex case management interventions

{=html} <!-- --> - Maintain goals and objectives of Tufts Health Plan in working with all enrollees for the coordination of services for the above enrollee population

{=html} <!-- --> - 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

{=html} <!-- --> - Continuously assess the enrollees needs and updates the plan of care per established policies and procedures

{=html} <!-- --> - Attend activities including clinical and other professional organization events as needed

{=html} <!-- --> - Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations

Maintain an active Massachusetts profession-specific license in good standing without restrictions

Other duties as assigned

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company\'s sole discretion and may be modified at the Companys sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently incl