Manager, CM – RN

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

📋 Description

• Supervise the care management team and oversee the care management for members.

• Create and evaluate high-quality, cost-efficient healthcare outcomes.

• Address escalations and care management concerns involving members or providers.

• Ensure all necessary care management documentation is reviewed for regulatory and contractual adherence.

• Formulate and execute policies and procedures for the care management team.

• Direct the daily operations of care management staff, including the assessment and approval of caseloads.

• Handle escalations and complex cases while providing guidance to team members.

• Facilitate the resolution of member escalations and complaints.

• Support audits and evaluations related to care programs and member issues.

• Design, implement, and manage care management programs.

• Conduct telephonic, digital, home, or other outreach to evaluate member needs.

• Establish team objectives and manage care management data and reporting metrics.

• Oversee care management audits to ensure compliance with federal, state, and NCQA standards.

• Provide constructive feedback to enhance member and provider experiences and quality of care.

• Educate and equip the care management team with resources on key initiatives and member outreach.

• Assist senior leadership with the onboarding, hiring, and training of team members.

• Lead and advocate for change within the scope of responsibility.

• Execute additional duties as assigned.

⛳️ Requirements

• RN license for the state of California is mandatory.

• Must be a graduate from an accredited nursing school or possess a bachelor's degree.

• A minimum of 5 years of relevant experience is required.

• Experience in Utilization Management (UM) and Care Management (CM) is preferred.

• RN state licensure and/or compact state licensure is necessary.

• Must hold a valid license in California.

• Ability to work during PST hours is essential.

• Adherence to all policies and standards is required.

🏝️ Benefits

• Competitive salary.

• Comprehensive health insurance.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in total compensation.

• Support for accommodations is available.