Manager, Case Management – California RN License Required

🕒 Maio 26

🏄 California – Remoto

🏄 California – Remote

💵 $113.332 - $169.999 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

💰 $135.000.000 Series C em 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health está comprometida em fornecer cuidados abrangentes para membros do Medicare, enfatizando as necessidades dos idosos, dos cronicamente doentes e daqueles que são frágeis. Com a missão de transformar a saúde dos idosos, a Alignment Health utiliza um modelo de atenção personalizado e tecnologia avançada para oferecer serviços de saúde de alta qualidade e baixo custo. Sua equipe de atendimento de concierge 24 horas por dia, 7 dias por semana, colabora com provedores locais confiáveis para garantir que cada membro receba um atendimento personalizado, refletindo o compromisso da empresa em tratar todos os membros como membros valiosos da família.

Descrição

• Oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members • Ensure compliance with CMS Model of Care requirements while driving quality, efficiency, and member-centered outcomes • Lead, coach, and develop a high-performing case management team serving SNP members • Ensure timely completion of: Health Risk Assessments (Initial & Reassessments) • Individualized Care Plans (ICPs) • Interdisciplinary Care Team (ICT) activities • Monitor operational and quality performance metrics and implement improvement strategies • Oversee regulatory audits, compliance initiatives, and quality assurance activities • Collaborate cross-functionally with: Utilization Management, HEDIS/STARS, Quality Improvement, Provider and Clinical Operations teams • Analyze reporting trends and operational data to support strategic decision-making • Promote a culture of accountability, collaboration, and continuous improvement • Support program growth and operational excellence within the Medicare Advantage SNP population

🎯 Requisitos

• Active, unrestricted California RN license • Associate’s or Bachelor’s Degree in Nursing • Minimum 5 years of clinical case management experience • Minimum 1 year of experience supporting SNP programs within a health plan environment • Willingness to obtain RN licensure in additional company markets, if needed • Strong understanding of: CMS SNP Model of Care • Medicare Advantage regulations • Care coordination and population health strategies

🏖️ Benefícios

• Fully remote flexibility • Opportunity to lead and grow within a rapidly expanding organization • Meaningful work improving outcomes for high-risk Medicare populations • Collaborative, mission-driven culture focused on quality care and innovation • Ability to influence and enhance case management programs at scale • Competitive compensation and benefits package