Back to Insights and Updates for ProvidersJune 2024

Care management Medicare role change

Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Medicare Preferred

As part of Point32Health’s efforts to continually evaluate and improve our processes, we want to update you on a change in responsibilities among the care management staff for our Tufts Medicare Preferred (internally managed only) and Harvard Pilgrim Health Care StrideSM (HMO)/(HMO-POS) Medicare Advantage plans.

While you may have worked previously with a Transition Manager when coordinating on transitions of care for members, we are integrating those functions into our existing Registered Nurse Care Manager (RNCM) roles over the coming month.

As a result, staff at extended care facilities and skilled nursing facilities will engage with RNCMs for the coordination of care for our members. In some cases, the RNCM you will be working with may be the same individual you previously collaborated with to facilitate your patient’s care through the Transition Manager role.

Care management roles and responsibilities for other product lines, including Tufts Health Plan Senior Care Options, are not affected.

The goal of this change is to enhance member outcomes, strengthen provider relationships, and support continuity of care for members across the care continuum. If you have any questions regarding this change, you may contact Tufts Medicare Preferred Provider Services at 800-279-9022 or Harvard Pilgrim Health Care Stride Provider Services at 888-609-0692.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

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