Manager, Large Case Management

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

📋 Description

• Provide strategic and operational oversight for the Large Case Management program.

• Directly manage daily operations through effective leadership of Supervisors, ensuring productivity, quality, timeliness, and adherence to documentation standards.

• Establish and track KPIs, recognize trends, and implement action plans to enhance outcomes and operational efficiency.

• Drive case management strategies for high-cost and complex cases to optimize clinical results and financial ramifications.

• Support the Case Management vendor strategy, performance assessment, and evaluation of referral suitability and outcomes.

• Ensure adherence to accreditation, regulatory, and contractual obligations, including state and federal regulations, URAC, NCQA, and HIPAA standards.

• Collaborate with Finance and executive leadership on stop loss reporting and high-cost claim analysis.

• Lead internal and external audits, quality assurance programs, and regulatory preparedness initiatives.

• Work in partnership with Utilization Management, Claims, Network, and Client Services.

• Identify and implement process enhancements to improve quality, efficiency, and scalability.

• Develop, execute, and uphold policies, procedures, and clinical guidelines.

• Provide leadership, mentorship, performance management, and career development opportunities for Supervisors and team members.

• Oversee the hiring, onboarding, training, and workforce planning processes.

• Communicate program performance, outcomes, and strategic insights to senior leadership.

• Lead and support change management initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• Registered Nurse with a minimum of 3–5 years of clinical nursing experience.

• At least 3 years in a healthcare leadership position, such as team lead or higher.

• Bachelor's Degree from an accredited college or university is required.

• Proven ability to manage and lead a team of direct reports.

• Exceptional written and verbal communication skills.

• Strong analytical capabilities with a keen attention to detail.

• Ability to identify improvement areas and formulate action plans.

• Positive, proactive, and team-oriented mindset and attitude.

• Solid knowledge of Microsoft Office applications.

• Current, active, and unrestricted RN license allowing practice in a state or territory of the United States.

• Relevant certifications such as Certified Case Manager (CCM) may be preferred.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment encouraging teamwork and collaboration.

• Flexible work arrangements may be available.