Clinical Manager (North Area - Middlesex and Essex County)

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, Point32Health 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 being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

Job Summary

Under the general direction of the Senior Manager or Director, Integrated Care Management - Nursing, the Manager, Integrated Care Management - Nursing, is responsible for day-to-day operations and staff within his/her jurisdiction. The Manager is responsible for implementation, monitoring and oversight of care management functions and programs, including assurance of quality evidence-based care management practice, adherence to regulatory and accreditation standards; and to delivery of defined metrics to validate business unit/program effectiveness. The Manager, Integrated Care Management - Nursing works collaboratively within Clinical Services and other Point32Health partner departments to identify and address opportunities to improve service, reduce administrative cost and support department, Line of Business (LOB) division, and organizational business goals. The Manager, Integrated Care Management - Nursing is also accountable for recruitment, evaluation, management, and ongoing development, of care management department staff, working in a remote and/or office environment. With his/her Care Management program, support members with chronic condition and complex medical needs including adult, geriatric, and pediatric and high-risk pregnancy. Members are identified as they transition to home following acute care or extended care admissions or emergency room use; in addition, members are referred by providers, self-referral, care givers and predictive modeling.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Business Process Implementation and Oversight:
  
  
  
  • Responsible for implementation and monitoring effectiveness of new and existing Care Management programs, including but not limited to:
  
  
  • Telephonic care management and onsite transition of care interventions
  
  
  • Compliance with applicable regulatory and accrediting standards; care management process and interventions consistent with national best practices; demonstrated through scheduled department and quality audits
  
  
  • Defining and monitoring outcomes and regular reporting for areas of accountability
  
  
  • Interface with Care Management vendors and programs for bidirectional referrals
  
  
  • Establishment of written policies and procedures pertaining to Care Management.
  
  
  
  


• Staff Development
  
  
  
  • Provide direct oversight of coordinators, RN care managers and other interdisciplinary staff working in a remote and/or office-based or hybrid environment. May supervise staff performing member home visits.
  
  
  • Guide and enhance the core competencies and professional development of reporting staff
  
  
  • Facilitate and enhance team collaboration to optimize program and member outcomes through integrated services,
  
  
  • Facilitate collaboration with internal and external stakeholders to maximize partnerships for case management program success, including alignment with provider network and employers
  
  
  • Serve as consultant and resource for complex situations.
  
  
  
  


• Resource Management
  
  
  
  • Oversee the management of department human resources related objectives
  
  
  • Support realization of department administrative budget targets
  
  
  
  


• Corporate Participation
  
  
  
  • Represent Care Management in relevant corporate teams as required
  
  
  • Implement and support fulfillment of corporate objectives within jurisdiction
  
  
  
  


• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• Registered Nurse with current unrestricted Massachusetts license required


• National Certification in Case Management is preferred

Education

• Required (minimum): Bachelor’s degree or equivalent relevant experience


• Preferred: BA/BS Degree

Experience

• Required (minimum): 5 years of RN experience in nursing in a clinical setting.


• Preferred: Experience in managed care systems and operations is highly desirable and must demonstrate sound knowledge of care management principles. 2-3 years of experience managing and leading a team. Expertise in oversight of business process change and leading people is. Prior home care experience.

Skill Requirements

• Excellent communication skills (verbal, electronic, etc.)


• Must possess skills and traits of an effective Coach, Mentor, and Critical Thinker.


• Demonstrates ability to manage and prioritize multiple complex issues throughout the workday in a flexible and professional manner.


• Must work well, both independently and autonomously as well as cooperatively as a team member across multiple levels within the organization


• Recognizes need to elevate issues and seek guidance appropriately


• Results orientation - strives to meet business goals in an ever-changing healthcare environment


• Demonstrated proficiency in reviewing clinical and financial data


• Knowledge and experience in effective case management interventions and strategies across populations


• Demonstrates strong clinical and critical thinking abilities


• Well-developed analytic skills, problem solving, as well as written and verbal communication skills


• Sound computer and technological skills


• Skilled negotiator, influencing others – particularly those outside of direct reporting relationships


• Capable of effectively encouraging, supporting, motivating, and leading others.


• Demonstrates collaboration in a way that boosts, promotes, and creates a positive work environment.


• Willing to share constructive criticism and feedback in a supportive, sensitive, and patient manner.


• Regard for confidential data and adherence to corporate compliance policy


• Must demonstrate commitment to excellence in customer service


• Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.


• Maintains the highest regard for confidential data and adherence to corporate compliance policy.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel)

• Must be able to work under normal office conditions and work from home as required.


• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.


• May be required to work additional hours beyond standard work schedule.


• May be required to travel to member homes with staff or facility or provider offices

COVID Policy

Please 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.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$111,974.40 -$167,961.60

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company’s sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Benefits

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  Medical, dental and vision coverage

  
  


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  Retirement plans

  
  


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  Paid time off

  
  


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  Employer-paid life and disability insurance with additional buy-up coverage options

  
  


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  Tuition program

  
  


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  Well-being benefits

  
  


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  Full suite of benefits to support career development, individual & family health, and financial health

  
  

For more details on our total rewards programs, visit

We welcome all

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.