Job Summary
Serves as a member of the Coordinated Whole Health Care team at Mass General Brigham Health Plan, the Nurse Care Manager conducts telephonic care disease management for members with respiratory (i.e. asthma, COPD, etc.) conditions. The Nurse Care Manager outreaches and works with members identified as higher risk. This includes partnering with members, providers, and families to create care plans that provide strategies to improve member health outcomes and help members meet self-identified health management goals.
Essential Functions
- Client Assessments and Planning
- Documents in accordance with NCQA requirements in member EMR
- Modify member treatment plans
- Defines care goals of cardiac patients by providing education, information, and direction to each individual and family
- Coordinates member care with other members of the Coordinated Whole Health Care team when appropriate
- Review cases with medical directors on challenging cases as needed
- Maintain accurate, detailed reports and records.
Qualifications
Education
- Associate's Degree Nursing required
- Bachelor's Degree Nursing preferred
Licenses and Credentials
- Massachusetts Registered Nurse (RN) license required
- Basic Life Support (BLS) certification required
- Respiratory experience highly preferred
- Previous teleophonic case management or home care experience highly preferred
Experience
- At least 2-3 years of case management, utilization review, or discharge planning experience preferred
Knowledge, Skills, and Abilities
- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry-related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
- Knowledge of Healthcare and Managed Care preferred.
Working Conditions
- This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville roughly once per quarter
- This is a full-time role with a Monday through Friday schedule, generally 8:30-5:00 PM Eastern Time
- Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy
Given equity, this position will pay somewhere between $90,000 to $110,000 annually.
Remote Type
Hybrid
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$58,656.00 - $142,448.80/Annual
Grade
98TEMP