Manager, Large Case Management

🕒 2 days ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Lucent Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2017-01

Healthcare • Healthcare Insurance • Fintech

Lucent Health is a data-driven health plan administration company that emphasizes a human-focused approach to healthcare. The company offers customized health plans tailored to the needs of employers and their employees, aiming to enhance care experiences while also reducing healthcare costs. With a focus on compassionate care management, Lucent Health utilizes analytics and member data to proactively support individuals through their healthcare journeys, ensuring they receive the right care at the right time.

📋 Description

• Provide strategic and operational leadership for the Large Case Management program • Oversee daily operations through direct leadership of Supervisors, ensuring productivity, quality, timeliness, and documentation standards • Establish and monitor KPIs, identify trends, and implement action plans to improve outcomes and efficiency • Lead case management strategies for high-cost and complex cases to optimize clinical outcomes and financial impact • Support Case Management vendor strategy, performance monitoring, and evaluation of referral appropriateness and outcomes • Ensure compliance with accreditation, regulatory, and contractual requirements, including state, federal, URAC, NCQA, and HIPAA requirements • Partner with Finance and leadership on stop loss reporting and high-cost claim analysis • Lead internal and external audits, quality assurance initiatives, and regulatory readiness efforts • Collaborate with Utilization Management, Claims, Network, and Client Services • Identify and implement process improvements to enhance quality, efficiency, and scalability • Develop, implement, and maintain policies, procedures, and clinical guidelines • Provide leadership, mentorship, performance management, and career development for Supervisors and team members • Oversee hiring, onboarding, training, and workforce planning • Communicate program performance, outcomes, and strategic insights to senior leadership • Lead and support change management initiatives • Perform other duties as assigned

🎯 Requirements

• Registered Nurse with a minimum of 3–5 years of clinical nursing experience • Minimum of 3 years in a healthcare leadership role, such as team lead or higher • Bachelor's Degree from an accredited college or university required • Demonstrated ability to manage and lead a team of direct reports • Excellent written and oral communication skills • Strong analytical skills with attention to detail • Ability to identify areas of improvement and develop action plans • Positive, proactive, team-oriented approach and attitude • Strong knowledge of Microsoft Office products • 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