Manager, Case Management – California RN License Required

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

📋 Description

• Supervise the daily operations of a comprehensive care management team dedicated to supporting Medicare Advantage SNP members.

• Ensure adherence to CMS Model of Care standards while promoting quality, efficiency, and member-focused results.

• Lead, mentor, and nurture a high-performing case management team that serves SNP members.

• Guarantee the timely completion of Health Risk Assessments (both Initial & Reassessments), Individualized Care Plans (ICPs), and Interdisciplinary Care Team (ICT) activities.

• Track operational and quality performance metrics and execute strategies for improvement.

• Manage regulatory audits, compliance efforts, and quality assurance initiatives.

• Collaborate across various functions, including: Utilization Management, HEDIS/STARS Quality Improvement, Provider, and Clinical Operations teams.

• Evaluate reporting trends and operational data to facilitate strategic decision-making.

• Foster a culture of accountability, teamwork, and ongoing improvement.

• Support the growth of programs and operational excellence within the Medicare Advantage SNP demographic.

⛳️ Requirements

• Current, unrestricted California RN license.

• Associate’s or Bachelor’s Degree in Nursing.

• At least 5 years of clinical case management experience.

• A minimum of 1 year of experience in supporting SNP programs within a health plan setting.

• Willingness to acquire RN licensure in additional company markets, if necessary.

• Strong knowledge of: CMS SNP Model of Care, Medicare Advantage regulations, care coordination, and population health strategies.

• Preferred Qualifications: BSN or MSN, 2+ years of leadership or supervisory experience in managed care or health plan operations, Case Management certification (CCM, ACM, or equivalent), and familiarity with utilization review criteria such as MCG guidelines.

🏝️ Benefits

• Fully remote flexibility.

• Opportunity to lead and advance within a rapidly growing organization.

• Meaningful work that enhances outcomes for high-risk Medicare populations.

• Collaborative, mission-driven culture that emphasizes quality care and innovation.

• Ability to influence and improve case management programs at scale.

• Competitive compensation and benefits package.