Manager Care Management, Senior Care Options South 1

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Under the general direction of the Senior Manager or Director, Integrated Care Management - Nursing, the Manager, Integrated Care Management - Nursing, is responsible for day-to-day operations and staff within his/her jurisdiction. The Manager is responsible for implementation, monitoring and oversight of care management functions and programs, including assurance of quality evidenced-based care management practice, adherence to regulatory and accreditation standards; and to delivery of defined metrics to validate business unit/program effectiveness. The Manager, Integrated Care Management -Nursing works collaboratively within Clinical Services and other Point32Health partner departments to identify and address opportunities to improve service, reduce administrative cost and support department, Line of Business (LOB) division, and organizational business goals. The Manager, Integrated Care Management - Nursing is also accountable for recruitment, evaluation, management, and ongoing development, of care management department staff, working in a remote and/or office environment. With his/her Care Management program, support members with chronic condition and complex medical needs including adult, geriatric, and pediatric and high-risk pregnancy. Members are identified as they transition to home following acute care or extended care admissions or emergency room use; in addition, members are referred by providers, self-referral, care givers and predictive modeling.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Business Process Implementation and Oversight:
  • Responsible for implementation and monitoring effectiveness of new and existing Care Management programs, including but not limited to:
  • Telephonic care management and onsite transition of care interventions
  • Compliance with applicable regulatory and accrediting standards; care management process and interventions consistent with national best practices; demonstrated through scheduled department and quality audits
  • Defining and monitoring outcomes and regular reporting for areas of accountability
  • Interface with Care Management vendors and programs for bidirectional referrals
  • Establishment of written policies and procedures pertaining to Care Management.
• Staff Development
  • Provide direct oversight of coordinators, RN care managers and other interdisciplinary staff working in a remote and/or office-based or hybrid environment. May supervise staff performing member home visits.
  • Guide and enhance the core competencies and professional development of reporting staff
  • Facilitate and enhance team collaboration to optimize program and member outcomes through integrated services,
  • Facilitate collaboration with internal and external stakeholders to maximize partnerships for case management program success, including alignment with provider network and employers
  • Serve as consultant and resource for complex situations.
• Resource Management
  • Oversee the management of department human resources related objectives
  • Support realization of department administrative budget targets
• Corporate Participation
  • Represent Care Management in relevant corporate tea