Lead Care Manager – PEAK

This is a fully remote position, open to applicants in United States.

📋 Description

• Onboard new team members and provide mentoring to the SNP care management staff.

• Deliver educational support, conduct documentation audits, and enhance the expertise of clinical team members through direct feedback and real-time coaching.

• Engage in activities associated with the development, implementation, oversight, and delegation of care management programs.

• Aid in ensuring adherence to CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.

• Contribute to the creation and execution of policies and procedures related to the Care Management process.

• Support the monitoring of performance standards, productivity, and ensure adequate staff coverage to fulfill departmental needs.

• Develop, implement, and assess educational strategies for staff development.

• Maintain an updated understanding of the requirements set forth by regulatory and compliance organizations.

• Mentor new Care Managers and assist with their training.

• Provide coaching and support to Care Managers and other clinical team members.

• Conduct data collection and trend analysis to identify areas for improvement and strategies for enhanced practices within the Care Management team.

• Handle escalated calls or temporarily support the Care Manager team during peak periods.

• Assist in quarterly reporting of delegated case management processes to comply with accreditation standards.

• Aid in the submission of necessary documents and policies during the application process to the accrediting body.

• Offer clinical, procedural, or interpretational assistance as needed.

• Capable of presenting complex ideas and data to a diverse range of stakeholders, from frontline employees to executive leadership.

• Establish and nurture cooperative and positive working relationships with key stakeholders across the organization.

• Participate in the Interdisciplinary Care Team (ICT) alongside the SNP CM team, PCP, and beneficiary/caregiver.

• Assist in utilizing Peak Health’s analytics tools to monitor HRA timeliness, care plan compliance, ICT effectiveness, utilization trends, and quality outcomes.

• Act as a vital liaison between SNP Care Management, Peak Health providers, pharmacy, behavioral health partners, and community organizations.

• Support the escalation and review of high-risk, high-need member cases to ensure appropriate interventions, community resource connections, and adjustments to care plans.

• Collaborate with Peak’s Quality Management and Compliance teams to enhance Stars improvement, HEDIS performance, utilization management coordination, and audit preparedness.

• Reinforce the escalation and review of high-risk, high-need member cases to guarantee suitable interventions, connections to community resources, and modifications to care plans.

⛳️ Requirements

• Must possess a current Registered Nurse license issued by the state where services will be provided or a current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).

• A minimum of five (5) years of clinical experience in healthcare.

• At least two (2) years of experience in Care Management, Case Management, or Population Health.

• Bachelor's Degree in Nursing OR an Associate of Science in Nursing Degree (ASN) or Diploma.

• Experience managing Medicare and/or Medicaid and/or SNP populations.

• Minimum of one (1) year of experience in SNP Care Management.

🏝️ Benefits

• Health insurance coverage.

• Paid time off for rest and recovery.

• Flexible work arrangements to support work-life balance.

• Opportunities for professional development and growth.