Senior Care Manager - Nursing

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 clinica