Care Manager - Allston, Back Bay, Boston, Brighton, Fenway, Jamaica Plain, Kenmore/Fenway, Miss[...]

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, it 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 a community of care and shared values; we are committed to inclusion and equal healthcare access for all backgrounds. Job Summary The Care Manager – Nursing Field (RN CM) will ensure that all members receive timely care management across the continuum, including transitions of care, care coordination & 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. Key Responsibilities and Duties Perform telephonic member outreach and/or face‑to‑face encounters utilizing motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate members holistically to identify needs, health goals, and barriers to wellness. Develop member‑specific care plans, implement interventions, and revise the plan as needed. Complete documentation in the 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, ensuring understanding of post‑hospital discharge instructions and implementing strategies to prevent readmission. Liaise with the interdisciplinary care team (utilization management, medical director, pharmacy, community health workers, dementia care specialists, wellness, and behavioral health case managers) to improve member outcomes. Attend and present high‑risk members at interdisciplinary rounds forums. Maintain professional growth and development through self‑directed learning activities. Qualifications Registered Nurse with current unrestricted license in the state of residence (and other states as required). Comprehensive knowledge of state‑specific Nurse Practice Act(s). National certification in case management desirable. Bachelor’s degree or relevant equivalent experience (minimum). Minimum of 5 years’ relevant clinical experience (preferred 5+ years). Experience in home care or case management; proficiency in a second language desirable. Experience in specialty areas a plus. Skills and Requirements Proficiency in Microsoft applications and technical concepts. Strong assessment, planning, and member‑care management skills. Advanced communication and interpersonal skills. Independent and autonomous with key job functions. Able to address multiple complex issues; flexible and adaptable to changing healthcare environment. Organize and prioritize work and member needs. Strong clinical and critical‑thinking skills. Adherence to corporate compliance and confidentiality policies. Working Conditions and Additional Requirements Work under normal office conditions and as a remote employee as required; simultaneous use of telephone/headset and PC/keyboard, sitting for extended periods. Provides face‑to‑face visits as needed. Valid driver’s license and vehicle in good working condition for travel. May be required to work additional hours beyond the standard schedule. COVID Policy We encourage all colleagues to follow CDC guidance regarding COVID‑19 vaccines, boosters, isolation, and masking. Point32Health reserves the right to adjust its requirements in response to COVID‑19 trends. Disclaimer The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification, and are not an exhaustive list of all responsibilities, duties, and skills required. Compensation & Total Rewards Overview Salary range: $87,073.33 – $130,609.99. The actual salary will be determined by scope, complexity, skills, education, training, credentials, and experience. Eligible for variable pay, benefits, and other forms of compensation at the company’s discretion. Benefits Medical, dental and vision coverage Retirement plans Paid time off Employer‑paid life and disability insurance with additional buy‑up options Tuition program Well‑being benefits Full suite of benefits supporting career development, individual & family health, and financial health Equal Opportunity Employer All applicants are welcome and 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. The company would never ask for a payment related to a job application or offer. If you have concerns about the legitimacy of a posting, contact View email address on click.appcast.io. #J-18808-Ljbffr P32HS Point32Health Services Inc