Job SummaryThe Care Manager - Nursing (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 nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which 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 doingAdminister assessments, collaborate with the member/caregiver and providers to develop a plan of care, implement member-specific CM interventions, and evaluate plan of care and revise as needed.Facilitate program enrollment utilizing key motivational interviewing skillsProvide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s carePerform both telephonic and face to face outreach to assess barriers to wellness, medical, behavioral, and psychosocial needs of the member.Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admissionPerforms case documentation in applicable CM system according to department and regulatory standardsCollaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and BH CM)Attend and present (as appropriate), high risk members at interdisciplinary rounds forumMaintain professional growth and development through self-directed learning activitiesOther duties and projects as assigned.Qualifications – what you need to perform the jobCOVID PolicyPlease note: We encourage all Point32Health colleagues to follow CDC guidance about COVID-19 vaccines, boosters, isolation and masking. Point32Health reserves the right to adjust its requirements in response to COVID-19 trends in the communities we serve.Education, Certification and LicensureRegistered Nurse with current unrestricted license in state of residence May be required to obtain other state licensure in states where Point32Health operatesBachelor’s Degree in Nursing preferredNational certification in Case Management desirableExperience (minimum years required):5+ years’ relevant clinical experienceExperience in home care or case management preferredProficiency in second language desirableExperience in specialty areas such as oncology, neurology, chronic condition/disease management a plusSkill RequirementsSkill and proficiency in technical concepts and principles; computer software applicationsSkilled in assessment, planning, and managing member careAdvanced communication and interpersonal skillsIndependent and autonomous with key job functionsAbility to address multiple complex issuesFlexibility and adaptability to changing healthcare environmentAbility to organize and prioritize work and member needsDemonstration of strong clinical and critical thinking skillsWorking Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):Must be able to work under normal office conditions and work from remote office as required.Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomesValid Driver’s license and vehicle in good working condition as some travel requiredMay be required to work additional hours beyond standard work schedule.Other duties as assigned and needed by the departmentCommitment to Diversity, Equity & InclusionPoint32Health is committed to making diversity, equity, and inclusion part of everything we dofrom product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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.Who We ArePoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities.Scam alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.