Community Care Manager

Community Care Manager

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric health plan based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role : As a Community Care Manager with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include coordinating care among our various healthcare partners to ensure comprehensive support for our members. Working together with our Providers coordinating wellness opportunities.

This position will work towards meeting clinical, financial and operational performance goals and standards.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Coordinating care among healthcare providers and services to ensure comprehensive support for our health plan members.
• Build relationships with the community healthcare systems to improve alignment with eternalHealth and foster growth.
• Actively perform and comprehensively document member and provider outreach and engagement activities to support complex care management, care coordination, disease management, and transitions of care.
• Perform comprehensive assessments of physical, emotional, psychosocial, and environmental needs of members and their caregivers.
• Create dynamic and fluid member-centered care plans to support health goals and improve health outcomes, continually evaluating for effectiveness.
• Work with Providers and the healthcare teams with HEDIS/STARS measures.
• Ensure members receive services that align with their benefit coverage and coordinate additional resources as required for holistic care.
• Follow and contribute to eternalHealth’s strategic goals related to population health management, quality improvement, and financial stewardship.
• Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI) and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
• Other duties as assigned.

Requirements:

• Excellent working knowledge of the Healthcare network within the Bristol and Plymouth Counties
• Portuguese highly valued
• Up to 95% Travel within Bristol and Plymouth counties using personal vehicle
• Active RN License
• Bachelor’s degree in nursing or equivalent work experience
• 3+ years of work experience in Hospital based care management.
• 1+ years of Health Plan experience is preferred.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Exceptional interpersonal skills with the ability to work in a fast-paced environment as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including with Microsoft Suite (Outlook, Excel, PowerPoint Word, etc.) and other collaborative tools.
• Valid MA Driver’s License
• A personal vehicle required for local travel

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email [email protected] with the email subject “Reasonable Accommodations – Applicant Name Here”.

Job Type: Full-time

Pay: $85,000.00 - $120,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Are you willing to take a drug test, in accordance with local law/regulations?
• Are you willing to undergo a background check, in accordance with local law/regulations?
• Do you have a valid driver's license?
• How many years of health plan experience do you have?

License/Certification:

• RN License in Massachusetts (Required)

Work Location: On the road