RN Care Manager, Tufts Medicare Preferred - Southern MA Territory at Tufts Health Plan in Watertown, Massachusetts

Job Description:

We enjoy the important work we do every day on behalf of our members.

Job Summary

Under administrative and clinical direction from the Care Manager, the Care Manager (CM) provides timely and clinically appropriate case management interventions to a geriatric population based on nationally recognized standards of case management practice and geriatric expertise. The CM will develop effective working relationships with members, families and providers in order to actively participate in the assessment of the member's needs and the development of individualized care plans, match the available health plan benefits and community services to those needs, coordinate the ongoing evaluation of the care plan, recommend and facilitate adjustments to the care plan and services in place, and focus on optimizing the member/family's level of independence in navigating the healthcare system at all levels of the continuum.
This role is the corner stone of assuring the most appropriate services and resources are provided for our members. Experience in working with the elderly in the community and coordinating care is a plus, as well as experience and comfort with difficult life issues including end-of-life.

Job Description

The CM will have a clear understanding of the role and will demonstrate a commitment to executing the following responsibilities:
Timely completion of documentation in the Members health care record using critical thinking skill and SMART goal setting
Assesses Member's health care needs in order to collaborate with the Member, their family and Providers to develop a quality and cost effective plan of care to improve, maintain or support optimal wellness with the context of the Member's illness, medical condition and plan benefits
Implementation of timely and clinically appropriate care management interventions
Facilitation of Member and Caregiver access to community resources relevant to the Member's needs
Manage and coordinate transitions of care ensuring all receive timely clinical data that may impact healthcare treatment decisions
Severs as a Member advocate and facilitator to resolve issues that may be barriers to care
Participates in department staff meetings or other on-site meetings as requested or required.
Identifies documents and refers potential QA occurrences to the Clinical Quality Department for review.
The Care Manager integrates utilization management knowledge and Case Management department policies and procedures within prospective, concurrent and retrospective case review activities to ensure effective utilization of resources and achievement of clinical and financial goals
. Participates in Team quality improvement projects by identifying opportunities to enhance present workflows/policies and presenting information to support a potential outcome improvement.

Requirements

Registered Nurse with unrestricted Massachusetts statelicense
Bachelor of Science is preferred
CCM is preferred
Minimum of 5 years Clinical Nursing
Experience in Medical Case Management highly desireable

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!.

Tufts Health Plan is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you d like more information on your EEO rights under the law, please click here.