Manager, Case Management – RN License Required

This is a fully remote position, open to applicants in Arizona, +1 more state.

📋 Description

• Lead, mentor, and nurture a high-performing case management team dedicated to serving SNP members.

• Ensure the prompt completion of Health Risk Assessments, Individualized Care Plans, and Interdisciplinary Care Team initiatives.

• Monitor operational and quality performance metrics, implementing strategies for improvement.

• Oversee regulatory audits, compliance efforts, and activities related to quality assurance.

• Collaborate with Utilization Management, HEDIS/STARS Quality Improvement, Provider, and Clinical Operations teams.

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

• Foster accountability, collaboration, and a culture of continuous improvement.

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

• Manage healthcare coordination for members with complex and chronic care requirements.

• Monitor and report on program performance, including the performance of delegated vendors.

⛳️ Requirements

• Active, 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 supporting SNP programs within a health plan environment.

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

• Strong knowledge of the CMS SNP Model of Care.

• In-depth understanding of Medicare Advantage regulations.

• Comprehensive knowledge of care coordination and population health strategies.

• BSN or MSN degree preferred.

• Over 2 years of leadership or supervisory experience in managed care or health plan operations preferred.

• Case Management certification (CCM, ACM, or equivalent) preferred.

• Familiarity with utilization review criteria such as MCG guidelines preferred.

• Strong leadership and team development skills.

• Exceptional communication and relationship-building abilities.

• Capability to analyze trends and drive performance effectively.

• Experience with EHR systems and healthcare technology platforms.

• Strong organizational, project management, and problem-solving skills.

• Ability to work efficiently in a fast-paced, collaborative, remote environment.

• Proficient in effective communication via phone and video conferencing.

• Close vision and the ability to adjust focus for computer-based tasks.

🏝️ 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 focused on quality care and innovation.

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

• Competitive compensation and benefits package.