The care manager will use the nursing and CMSA standards to provide care management to NHP
members on an ongoing basis, within the members benefit package. The care manager will
initiate and maintain communication with members, PCP and other health team members regarding
care plan, identify complex, high risk members for care management and referrals as
appropriate, especially those requiring benefit exception. Will function as a team member and
participate in multidisciplinary teams. The care manager will participate in quality
improvement initiatives within the clinical operations department and will be responsible for
participating in work group initiatives directly related to the program they support,
including external meetings. He/she will be responsible for maintaining accurate information
in NHP's CS2000 system.
Responsible for completing work in a timely manner. Turn around times will meet compliance
requirements for Division of Insurance, NCQA and departmental standards. Must be able to
manage competing priorities and have the ability to multi task. Must be flexible to meet the
business needs of the department. He/she may be required to work on special or high priority
projects in addition to the day to day care management work.
The Care Manager will assess, plan, implement, and evaluate care plans for NHP members. He/she
will collaborate with social care managers, as well as behavioral health care managers, to
develop a comprehensive approach to care coordination.
Excellent verbal and written communication skills.
Demonstrated ability to multi-task.
Works with minimal or direct supervision.
Demonstrated creativity in formulating care plans from assessment and clinical information.
Use of evaluative and outcomes data to improve ongoing care management services.
Promotion of health care outcomes in concert with currently accepted clinical practice
Adherence to the code of ethics for the care manager's professional discipline.
Development and maintenance of collaborative, proactive and patient focused relationships to
maximize client health care outcomes.
Serving as a member advocate.
Building collaborative working relationships with Health Center / Provider partner staff,
including participating in regularly scheduled site visits to promote NHP care management
Participation in work groups specific to the program they are working on.
Participation in quality improvement initiatives within the clinical operations department.
Competency with Windows based systems, Microsoft Office applications.
Competence in or ability to learn NHP Care Management software, CS2000 or other as required.
Some local travel required at times
Education & Experience
Active Massachusetts RN or other Health Care professional license
Bachelors degree or equivalent work experience.
3-5 years acute or program-specific population/disease expertise.
CCM, Managed Care, Home Health Nursing.
Web based research.
Review of Criminal Background
To apply for a position, please email a copy of your resume to Careers@nhp.org You may also
submit your resume through fax at (617) 478-7198 or mail it to Human Resources, Neighborhood
Health Plan, 253 Summer Street, Boston, MA. 02210.