Manager, Case Management – RN License Required

🔥 5 minutes ago

🌵 Arizona, California – Remote

🌵 Arizona – 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

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• 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

🎯 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 • 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

🏖️ 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