SCO RNCM Metro West- Worcester
SCO RNCM Metro West- Worcester
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1 Vacancy
Job Description
Who We Are
Point32Health is a leading health and wellbeing organization delivering an everbetter 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
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 memberspecific goals. Based on national standards for CM practice the RN CM focuses on empowering the member to support optimal wellness and improved selfmanagement.Job Description
- Administer assessments collaborate with the member/caregiver and providers to develop a plan of care implement memberspecific CM interventions and evaluate plan of care and revise as needed.
- Facilitate program enrollment utilizing key motivational interviewing skills
- Provide targeted health education proactive strategies for condition management and communication with key providers and vendors actively involved in the members care
- Perform both telephonic and face to face outreach to assess barriers to wellness medical behavioral and psychosocial needs of the member.
- Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care which includes but is not limited to ensure understanding posthospital discharge instructions facilitate needed services and followup and implement strategies to prevent readmission
- Performs case documentation in applicable CM system according to department and regulatory standards
- Collaborates and liaises with the interdisciplinary care team to improve member outcomes (i.e. Utilization Management Medical Director pharmacy community health workers dementia care specialists wellness and BH CM)
- Attend and present (as appropriate) high risk members at interdisciplinary rounds forum
- Maintain professional growth and development through selfdirected learning activities
- Other duties and projects as assigned.
COVID Policy
Please note: We encourage all Point32Health colleagues to follow CDC guidance about COVID19 vaccines boosters isolation and masking. Point32Health reserves the right to adjust its requirements in response to COVID19 trends in the communities we serve.
Education Certification and Licensure
- Registered Nurse with current unrestricted license in state of residence
- May be required to obtain other state licensure in states where Point32Health operates
- Bachelors Degree in Nursing preferred
- National certification in Case Management desirable
Experience (minimum years required):
- 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
Skill Requirements
- Skill and proficiency in technical concepts and principles; computer software applications
- 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
Working Conditions and Additional Requirements (include special requirements e.g. lifting travel):
- 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 Drivers license and vehicle in good working condition as some travel required
- May be required to work additional hours beyond standard work schedule.
- Other duties as assigned and needed by the department
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities duties and skills required of employees assigned to this position. 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 andbenefits remains in the Companys sole discretion and maybe modified at the Companys 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
Employerpaid life and disability insurance with additional buyup coverage options
Tuition program
Wellbeing benefits
Full suite of benefits to support career development individual & family health and financial health
For more details on our total rewards programs visit 32health/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 dofrom product design to the workforce driving that innovation. Our Diversity Equity Inclusion Accessibility (DEIA) and Health Equity teams 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
Employment Type
Full-Time
