Manager, Case Management – RN License Required

🕒 vor 1 Tag

🌵 Arizona, California – Remote

🌵 Arizona – Remote 🏄 California – Remote

💵 $113.332 - $169.999 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

👔 Manager

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Alignment Health

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2013

⚕️ Krankenversicherung

🛡️ Versicherung

🏥 Gesundheitswesen

💰 €135.000.000 Series C im 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health engagiert sich für die Bereitstellung umfassender Pflege für Medicare-Mitglieder, wobei der Fokus auf den Bedürfnissen von Senioren, chronisch Kranken und gebrechlichen Personen liegt. Mit der Mission, das Gesundheitswesen für Senioren zu transformieren, nutzt Alignment Health ein maßgeschneidertes Pflegemodell und fortschrittliche Technologie, um qualitativ hochwertige, kostengünstige Gesundheitsdienstleistungen anzubieten. Ihr 24/7-Konzierge-Pflegeteam arbeitet mit vertrauenswürdigen lokalen Anbietern zusammen, um sicherzustellen, dass jedes Mitglied eine individuelle Betreuung erhält, was das Engagement des Unternehmens widerspiegelt, alle Mitglieder als geschätzte Familienmitglieder zu behandeln.

Beschreibung

• Lead, coach, and develop a high-performing case management team serving SNP members • Ensure timely completion of Health Risk Assessments, Individualized Care Plans, and Interdisciplinary Care Team activities • Monitor operational and quality performance metrics and implement improvement strategies • Oversee regulatory audits, compliance initiatives, and quality assurance activities • Collaborate with Utilization Management, HEDIS/STARS Quality Improvement, Provider, and Clinical Operations teams • Analyze reporting trends and operational data to support strategic decision-making • Promote accountability, collaboration, and continuous improvement • Support program growth and operational excellence within the Medicare Advantage SNP population • Manage health care coordination for members with complex and chronic care needs • Monitor and report program performance, including delegated vendor performance

🎯 Anforderungen

• 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 • Strong understanding of Medicare Advantage regulations • Strong understanding of care coordination and population health strategies • BSN or MSN preferred • 2+ years of leadership or supervisory experience in managed care or health plan operations preferred • Case Management certification (CCM, ACM, or equivalent) preferred • Experience with utilization review criteria such as MCG guidelines preferred • Strong leadership and team development capabilities • Excellent communication and relationship-building skills • Ability to analyze trends and drive performance • Experience working with EHR systems and healthcare technology platforms • Strong organizational, project management, and problem-solving abilities • Ability to work effectively in a fast-paced, collaborative, remote environment • Ability to communicate effectively via phone and video conferencing • Close vision and ability to adjust focus for computer-based work

🏖️ Vorteile

• 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