Manager, Case Management – California RN License Required

🕒 June 17

🏄 California – Remote

🏄 California – Remote

💵 $113.3k - $170k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

👥 B2C

💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11

Healthcare Insurance • B2C

Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.

📋 Description

• 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

🎯 Requirements

• 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 • Preferred Qualifications: BSN or MSN 2+ years of leadership or supervisory experience in managed care or health plan operations Case Management certification (CCM, ACM, or equivalent) Experience with utilization review criteria such as MCG guidelines

🏖️ Benefits

• 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