Nurse Care Manager - Boston, Charlestown, Dorchester East Boston, North End, South B

Who We Are

Point
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Health is a leading not‑for‑profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. Serving nearly 2 million members, we build 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, guided by shared values that emphasize inclusion and equal healthcare access regardless of background.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us provide service with empathy and better understand and meet the needs of our communities.

The Care Manager – Nursing Field (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 RN CM possesses strong clinical knowledge, critical thinking skills, and the ability to facilitate a care plan that 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 member‑specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal wellness and improved self‑management.

Key Responsibilities/Duties – what you will be doing:

• Perform telephonic member outreach and/or face‑to‑face encounter utilizing key motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness. Through assessment and collaboration with member/caregiver and providers, develop a member‑specific plan of care, implement member‑specific care manager interventions, and revise plan as needed. Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, including ensuring understanding of post‑hospital discharge instructions, facilitating needed services and follow‑up, and implementing strategies to prevent readmission.
• Collaborate and liaise with the interdisciplinary care team to improve member outcomes (e.g., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM). Attend and present (as appropriate) high‑risk members at interdisciplinary rounds forum.
• Maintain professional growth and development through self‑directed learning activities.

• Registered Nurse with current unrestricted license in state of residence.
• May be required to obtain other state licensure in states where Point
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  Health operates.
• Understand and follow the provisions of state‑specific Nurse Practice Act(s) where Point
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  Health operates.
• National certification in Case Management desirable.

• Required (minimum):
  Bachelor’s degree or relevant equivalent experience.
• Preferred:
  Bachelor’s degree in nursing.

• Required (minimum): 5 years’ relevant clinical experience.
• Preferred:
  Experience in home care or case management.
• Proficiency in a second language desirable.
• Experience in specialty areas a plus.

• Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications.
• Work cooperatively as a team member across multiple levels within the organization.
• 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…