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, click here.

Job Summary

The Senior Care Manager - Nursing is responsible for assisting the Care Management (CM) leadership team in the delivery of a clinical and business model at Point32Health. The Senior Care Manager - Nursing serves as a resource person for the day-to-day operations of nurse care managers who provide , care management, and population health support for a subset of members status post facility discharge and/or with complex and chronic conditions. The Senior Care Manager - Nursing may be responsible for or assist with the onboarding of all new staff members in the department and works collaboratively with the enterprise training team to ensure a comprehensive orientation program. This work requires a fundamental and solid understanding of all the roles and documentation standards within the department. The Senior Care Manager - Nursing also identifies gaps, analyzes and identifies trends that may require additional department training

Key Responsibilities/Duties – what you will be doing

General Staff Support and Development

Provide leadership and direction to team members under the guidance of the Clinical Manager.

Provide ongoing updates to the Clinical Manager regarding issues raised by the Care Management team.
Serve as a subject-matter-expert (SME) to Care Managers in all areas: transition management, complex care management, out of area (OOA) care management.
First line resource for daily Care Management issues.
Strong understanding and application of CM documentation system and other software applications needed to perform CM and non-clinical job functions.
Solid computer skills and ability to create documents such as checklists, job aids, and workflows to support staff daily work.
Collaborate with the Clinical Managers in conducting and trending CM documentation audits. Assist in the implementation of process improvements as identified by the audits.
Maintain collaborative relationship with Enterprise training team and recommends CE opportunities, gaps in CM standards of practice.
Attends and provides feedback on interdisciplinary care team meetings.
May act as liaison to specified employer or provider groups.
May need to attend external meetings.
Collaborate with internal departments (Utilization Management, Provider Performance, Clinical Strategy, Sales).
Participate in staff and leadership meetings as appropriate.
May have CM caseload if needed to support department. May provide coverage for CM team when there are staffing coverage challenges.
Champion change and effectively manage the implementation of new ideas.
Participate in organizational planning and projects.
Observes interdisciplinary rounds, huddles, ICTs (Information Communications Technology) and provides feedback and training as needed.
Work with the provider performance team to develop trainings, perform chart audits and recommend process change to impact re-admissions, ED visits, and adverse utilization patterns.

Corporate Participation

Participate in corporate/departmental committees and workgroups as needed.
Participate on committees or projects externally and/or cross functionally.
Other duties and projects as assigned.

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

Registered Nurse with current unrestricted Massachusetts license required
Bachelor’s or Advanced Degree in nursing preferred
National certification in Case Management desirable

EXPERIENCE (minimum years required):

7 years’ relevant clinical experience required
2 years’ care management experience at Point32Health preferred

SKILL REQUIREMENTS:

Demonstrates ability to manage and prioritize multiple complex issues throughout the workday in a flexible and professional manner.
Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.
Recognizes need to escalate issues and seek guidance appropriately
Work cooperatively as a team member across multiple levels within the organization
Results orientation - strives to meet business goals
Demonstrated proficiency in reviewing clinical and financial data
Knowledge and experience in effective case management interventions and strategies across populations
Demonstrates strong clinical and critical thinking abilities
Well-developed analytic, problem solving, written and verbal communication skills
Sound computer and technological skills, including proficiency in Microsoft applications
Skilled negotiator, influencing others – particularly those outside of direct reporting relationships
Capable of encouraging, supporting, motivating, and leading others.
Demonstrates collaboration in a way that boosts, promotes, and creates a positive work environment.
Willing to share constructive criticism and feedback in a supportive, sensitive, and patient manner.
Regard for confidential data and adherence to corporate compliance policy

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May require travel depending on needs of the department
May be required to work additional hours beyond standard work schedule.

DISCLAIMER

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 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