Care Manager 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 the administrative direction of the Clinical Manager, the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to manage all aspects of member care for a panel of frail elderly, while working within a healthcare team. The NCM directly interfaces with physicians, other members of the primary care team, members, and their caregivers in identifying risk factors, conducting assessments, and developing and implementing care plans to comprehensively manage their members' care.

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance) % of TIME
(Optional)
The NCM will have a clear understanding of the role and will demonstrate a commitment to executing on the following responsibilities:
* Timely completion of initial and ongoing geriatric assessments
* Development and communication (with member, caregiver and primary care physician/primary care team) of an individualized plan of care
* Completion of the Minimum Data Set-Home Care (MDS-HC)
* Facilitation of member and caregiver access to community resources relevant to the member's needs, including referrals to Adult Day Health, Adult Foster Care and the Personal Care Attendant Program.
* Participation in routine primary care team meetings
* Pro-active management and follow-up (via home visits and by telephone) according to the member's care plan
* Management and coordination of all transitions of care, including:
o Communicating care plan to providers in all settings of care (ED, hospital, rehabilitation facility, nursing home, home care) and ensuring providers receive timely clinical data that may impact healthcare treatment decisions
* Direct caregiver support
* Serves as a member advocate and facilitator to resolve issues that may be barriers to care
* Provide education and coaching to the member, family, and/or caregiver about health status, treatment options, goals of care, and health insurance benefits to assist members in making the most informed decisions and help promote self-management

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

EDUCATION: (Minimum education & certifications required)
* Bachelors of Science in Nursing (BSN) and Registered Nurse with current, unrestricted state license is required.

EXPERIENCE: (Years of experience)
* Minimum 3 years clinical nursing experience required
* Experience in case management managing geriatric/chronic illness populations required
* Experience within a SCO program highly preferred
* Experience in Medicare and/or Medicaid managed care preferred
* Proficient in computer use, the Internet, and health information technology required
* Case management certification a plus

SKILL REQUIREMENTS: (Include interpersonal skills)
* Work cooperatively as a team member across multiple levels within the organization
* Demonstrate initiative in achieving individual, team, and organizational goals and objectives
* Must be able to prioritize work and develop strategies for adapting to constantly changing priorities and urgencies.
* Regard for confidential data and adherence to corporate compliance policy
* Demonstrate cultural competency and sensitivity
* Demonstrate the ability to work autonomously
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)
* Ability to travel frequently to member's homes, hospitals, skilled nursing facilities, PCP office practices and other sites where patients receive care.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.

Job Description

Requirements

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!

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