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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.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health (https://www.point32health.org/) .

Job Summary

Under the administrative direction of the Director of Care Management/ Senior Manager, the SCO Clinical Manager is responsible for leading the delivery of a clinical and business model of the Senior Care Options Transitions/Post-Acute programs. The Clinical Manager is part of the Care Management leadership team and oversees the day to day operations of nurse care managers who provide, care coordination and population health support for of SP SCO members with complex and chronic conditions. In addition, the Clinical Manager is accountable for oversight and management of the Transitions of care processes (including discharge planning, extended care, and long-term care management). The Clinical Manager provides Subject Matter Expertise (SME) related to SCO program regulatory requirements and THP SCO Model of Care. The Clinical Manager will also work closely with the SCO management team to monitor Utilization metrics specifically related to Acute/SNF admission and readmission rates. This work requires an understanding of the data points responsible for utilization and cost as well as a demonstrated competency in identifying and implementing targeted interventions that would best suit the specific cost/utilization driver.

The Clinical Manager will collaborate with the key members of the Senior Products interdisciplinary team (including but not limited to Clinical NPs, Pharmacist, Social Workers, Clinical Trainer, SCO Clinical Consultants) to develop and refine an evidence based geriatric-focused care management program to support Senior Products. The SP SCO Clinical Manager works collaboratively with other members of the SP CM Leadership team, SP Medical Directors, Risk Adjustment and Contracting teams and other appropriate Tufts HP staff in order to meet the corporate and/or program goals of the SCO program. The Clinical Manager is accountable for recruitment, evaluation, management, and development of clinicians they oversee

Job Description

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Job Summary

Under the administrative direction of the Director of Care Management/ Senior Manager, the SCO Clinical Manager is responsible for leading the delivery of a clinical and business model of the Senior Care Options Transitions/Post-Acute programs. The Clinical Manager is part of the Care Management leadership team and oversees the day to day operations of nurse care managers who provide, care coordination and population health support for of SP SCO members with complex and chronic conditions. In addition, the Clinical Manager is accountable for oversight and management of the Transitions of care processes (including discharge planning, extended care, and long-term care management). The Clinical Manager provides Subject Matter Expertise (SME) related to SCO program regulatory requirements and THP SCO Model of Care. The Clinical Manager will also work closely with the SCO management team to monitor Utilization metrics specifically related to Acute/SNF admission and readmission rates. This work requires an understanding of the data points responsible for utilization and cost as well as a demonstrated competency in identifying and implementing targeted interventions that would best suit the specific cost/utilization driver.

The Clinical Manager will collaborate with the key members of the Senior Products interdisciplinary team (including but not limited to Clinical NPs, Pharmacist, Social Workers, Clinical Trainer, SCO Clinical Consultants) to develop and refine an evidence based geriatric-focused care management program to support Senior Products. The SP SCO Clinical Manager works collaboratively with other members of the SP CM Leadership team, SP Medical Directors, Risk Adjustment and Contracting teams and other appropriate Tufts HP staff in order to meet the corporate and/or program goals of the SCO program. The Clinical Manager is accountable for recruitment, evaluation, management, and development of clinicians they oversee.

Job Description

Business Process Implementation and Oversight

Accountable for the implementation and refinement when necessary of the Senior Products clinical model and for the performance of the care management team, as well as the clinical performance of the Medical Group/IDN. Also responsible to develop and implement processes and procedures to support the adherence to the clinical model and identified condition/disease management programs. To support the execution phase of the care management program, the Clinical Manager will act as a clinical consultant to the care managers on individual cases and identify additional opportunities for growth and development of the clinical team. To support the clinical performance of the medical group the Clinical Manager will act as a clinical SME and make recommendations, secure buy-in and/or engagement of medical group leader (when leader is identified) and execute clinical strategies to improve performance. These responsibilities include, but are not limited to:

+ Oversight and monitoring of the day-to-day care management functions.

+ Review and evaluation of key clinical/financial data as it relates to cost and utilization for designated medical groups

+ Collaboration with the SP CM leadership team and other key stakeholders to monitor/manage /develop/implement clinically focused programs/initiatives to improve performance.

+ Work collaboratively with other members of the SP CM Leadership team, SP

+ Medical Directors and other appropriate Tufts HP staff to identify and address opportunities to manage utilization/cost, improve quality, identify gaps in knowledge or services, reduce administrative cost and demonstrate outcomes for clinical, financial and utilization functions and programs.

+ Ongoing communication and partnership with Network Contracting and Allied Health departments to develop and implement strategies to optimize the critical relationships with our community partners (Home Care agencies Skilled Nursing Facilities, Acute Inpatient Care Facilities vendors, etc.)

Medical Group Clinical Performance Management

+ Review and evaluation of key clinical/financial data as it relates to cost and utilization for designated medical groups

+ Identify the key drivers of unfavorable clinical performance

+ Create and execute clinical action plans to address clinical performance

+ Collaborate with medical group or key constituencies to execute action plan

+ Reevaluate and refine clinical action plan as needed.

+ Share best practices on clinical performance

General Management/Staff Support and Development

+ Hire and retain staff

+ Maintain a performance management system for overseeing staff performance

+ Coach and develop nurse care managers

+ Organize and facilitate team meetings as appropriate

+ Champion change and effectively manage the implementation of new ideas

+ Participate in organizational planning and projects

Corporate Participation

+ Represent SP Clinical Care Management in relevant corporate teams as required

+ Implement and support fulfillment of corporate objectives within scope

Compensation & Total Rewards Overview

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.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

+ Medical, dental and vision coverage

+ Retirement plans

+ Paid time off

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

+ Tuition program

+ Well-being benefits

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

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

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.

**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 [email protected]

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 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.