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Point32Health Clinical Liaison in Boston, Massachusetts

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.

Job Summary

The Clinical Liaison is responsible for educating potential members, partners, healthcare professionals, and community related service providers about Point32 Health Senior Care Options (SCO) program and its core capabilities. This position involves one on one interaction, presentations, and professional education activities with applicable members and healthcare professionals. Using clinical expertise to collaborate with Business Development, potential members, network providers and vendors to maintain positive relationships in order to increase participation and satisfaction in an effort to grow and retain membership.

Key Responsibilities/Duties – what you will be doing

  • Provides clinical expertise in support of the sales efforts by utilizing clinical skills to assist with member intakes.

  • Assists newly enrolled/potential members with onboarding to Point32Health SCO to identify appropriate plan code, current services, and existing agencies for members to prevent/minimize any disruptions to service and maintain current/similar appropriate service by communicating with member, agencies, and other internal SCO teams.

  • Reviews New Opportunity Questionnaire for Home and Community Based agencies and present to Business Development team and Clinical for possible contract.

  • Maintains a comprehensive working knowledge of community resources, payer requirements, and network services for target population.

  • Participates in outreach opportunities to promote health awareness at community events hosted/sponsored by the SCO teams, including blood pressure/blood glucose screening and health education presentations.

  • Engages in the exploration of new ideas and constructive problem solving with the Sales and Marketing team, Provider Relations and Network Development team, and Clinical team.

  • Identifies barriers to achieving contracting goals and enrollment growth and recommend solutions.

  • Identifies and assess trends that may impact growth and enrollment (i.e., Disenrollment).

  • Participates in provider meetings/trainings by utilizing their clinical background to address provider’s inquiries regarding clinically focused components of model of care and processes and to identify opportunities to improve clinical collaboration.

  • Prepares for and participates in clinical presentations.

  • Educates providers, potential members, and new enrollees about the SCO plan benefits, policies, and procedures.

  • Educates existing and new providers about SCO care transitions management practices, onboarding process, and model of care through effective and timely communication.

  • Adheres to SCO department documentation policies and procedures.

  • Provides excellent customer service to external and internal customers

  • Other duties and projects as assigned.

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

  • Registered Nurse licensed in Massachusetts required

  • Must possess valid driver’s license and reliable transportation for community travel

  • Must obtain a Producer’s license relative to health insurance sales within 3 months of hire. Must maintain license by completing CEU requirements and annual exam.

EXPERIENCE (minimum years required) :

  • 3-5 years of current clinical nursing experience preferred with home care, case management, acute care, or physician office.

  • 2 years’ experience in managing geriatric/chronic illness population and working with a geriatric population required

  • Knowledge of Medicare and Medicaid programs required.

  • Medicare/Medicaid managed care experience preferred.

  • Strong knowledge of chronic disease management preferred.

  • Network of existing relationships with providers highly desirable.

  • Knowledge of Aging Services Access Point (ASAP) function and services preferred.

  • Knowledge of Home and Community Based Services along with keeping up to date with regulation changes preferred.

SKILL REQUIREMENTS:

  • Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management

  • Outstanding written and oral communication and customer service skills

  • Strong computer skills: competent in Microsoft Office Products (Outlook, Word, Excel)

  • Ability to work independently and maintain flexibly in fast paced environment

  • Self- starter with high level of accountability and responsibility for outcome of care

  • Highly organized and able to manage multiple priorities appropriately

  • Independent problem-solving skills

  • Able to work collaboratively and build enduring relationships with providers, members, and the multidisciplinary team

  • Comfortable with presenting to internal department staff, prospects, and providers, including senior level executives.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel) :

  • 50% travel is required in order to perform the functions of this role.

  • Must be able to work under normal office conditions and work from home as required.

  • Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

  • May be required to work additional hours beyond standard work schedule.

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Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.

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