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.

Job Description

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS

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

Requirements

EDUCATION: (Minimum education & certifications required)

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

• Case management certification a plus

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.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About Us

Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, 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.

At Point32Health, we’re working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R4290