RN Care Manager at Tufts Health Plan in Providence, Rhode Island

Job Description:

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

Job Summary

The care manager will ensure that Tufts Health Plan members receive timely care management across the continuum of care including complex case management, care coordination, population health and wellness interventions, and disease management per guidelines as established by the Integrated Care Management team at Tufts Health Public Plan (THPP). This position will be responsible for implementation and coordination of care management interventions across the continuum for identified members, both in a specific program or simply in need of more intensive, long-term services than provided in episodic case management. The care manager will work closely with the member, family/authorized representative, and providers to develop a member specific care plan to meet the targeted goals.

Job Description

• Perform in-person outreach visits throughout the state as necessary for purposes of engagement and enhanced care coordination with members, providers, and other collateral supports

• Use all available methods of communication to connect with members, including, but not limited to, telephonic, in-person, or written communication.

• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

• Promotes integration of services for members including behavioral health care and physical health to enhance the continuity of care for RITogether members.

• Complete clinical assessments of members who request care management (CM) services, are referred by a provider/facility, or are identified by data as having high need potential

• Develops and implements a care plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

• May implement specific THPP wellness programs, e.g., chronic disease management.

• Uses motivational interviewing to support and motivate change during member contacts.

• Provide targeted health education to the member, and their family members/caregivers about available benefits, community resources, health care alternatives, and the importance of proactive disease and/or condition management approaches healthcare and wellness.

• Ensure member receives clinical disease management support, including education, and teaching self-management strategies

• Collaborates with THPP care management team members, division-wide colleagues, and community-based providers to provide integrated care for at-risk members

• Travel within Rhode Island up to 80% may be required, depending on the complexity level of the assigned members

• Facilitate communication between the care manager and member, and the member with their practitioners to promote empowering the member to take an active role in managing their health

• Communicates with all providers actively involved in the member's care regarding individualized care plan progress, specific program participation, and complex case management interventions

• Maintain goals and objectives of Tufts Health Plan in working with all members for the coordination of services for the above member population

• Continuously assess the member's needs and updates the plan of care per established policies and procedures

• Attend activities including clinical and other professional organization events as needed

• Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations

• Maintain an active Rhode Island license in good standing without restrictions

• Complies with departmental workflow and documentation policies and procedures

Requirements

EDUCATION: (Minimum education required)

• RN with current RI license


• Bachelor's Degree preferred


• CCM preferred

EXPERIENCE: (Years of experience)

• One or more years as a community-based care manager (required)


• One or more years of Behavioral Health experience (preferred)


• One or more years working in a managed care organization (preferred)
  
  

SKILL REQUIREMENTS: (Include interpersonal skills)

• Skill and proficiency in applying highly technical principles, concepts, and techniques that are central to the nursing profession


• Skill in assessing, planning, and managing patient care as acquired through three years of clinical nursing experience in an acute care hospital; rehabilitation or home care experience


• Advanced communication and interpersonal skills with all levels of internal and external customers


• Knowledge of computer software applications; CCMS a plus


• Good organizational and prioritizing skills


• Valid Driver's License and vehicle in good working condition, with ability and willingness to travel up to 10 times per month, in assigned geographic region and throughout the state as necessary

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)

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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