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.

Job Summary

Under the administrative direction of the Clinical Manager, the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to conduct assessments for frail elderly population, while working within a healthcare team. The RNCM 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 members’ care.

Key Responsibilities/Duties – what you will be doing

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

Timely completion of all types of 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.
Pro-active management and follow-up (via home visits and by telephone) according to the member’s care plan
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
SCO RN Care Manager per diem positions are required to meet a minimum productivity of 25 face to face assessments per month, which would be a mix of initial assessments, annual assessments and ongoing assessments not to exceed 25 assessments/month. This includes the entire process of each assessment to be considered complete.

Qualifications – what you need to perform the job

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.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.

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 Company’s sole discretion, consistent with the law.

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

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

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

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.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org