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Tufts Health Public Plans Inc SCO Per Diem Care Management South Shore Elder Services Area - R7585 in Seattle, Washington

Who We Are

Point32Health 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. To learn more about who we are at Point32Health, click here{rel="nofollow" https:="" youtu.be="" s5i_hgoecjq="" ""="" target="" _blank""=""}.



Job Summary

Under the administrative direction of the Clinical Manager, the Nurse Case Manager (NCM) for Senior Care Options (SCO) is responsible to conduct assessments for frail elderly population, while working within a healthcare team. The RNCM 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 members' care.


Key Responsibilities/Duties -- what you will be doing

The RNCM will have a clear understanding of the role and will demonstrate a commitment to executing on the following responsibilities:

  • Timely completion of all types of 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.

  • Pro-active management and follow-up (via home visits and by telephone) according to the member's care plan

  • 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

  • SCO RN Care Manager per diem positions are required to meet a minimum productivity of 25 face to face assessments per month, which would be a mix of initial assessments, annual assessments and ongoing assessments not to exceed 25 assessments/month. This includes the entire process of each assessment to be considered complete.


Qualifications -- what you need to perform the job

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 organiz