Manager, Case Management, RN
Location
California
Posted
16 days ago
Salary
$113.3K - $170.0K / year
Associate Degree5 yrs expEnglish
Job Description
• Responsible for the health care management and coordination of care for members with complex and chronic care needs
• Assures compliance with SNP program requirements as outlined in the Model of Care
• Monitors activities to support the timeliness of Health Risk Assessment completion
• Monitors and reports program performance, including vendor performance monitoring
• Oversee audits, regulatory compliance, and quality assurance activities
• Provide coaching, performance reviews, and staff development to support team success
Job Requirements
- Minimum 5 years of clinical case management experience
- Minimum 1 year of experience working with SNP programs in a health plan
- California RN license required
- Willing to obtain an RN license in all of our states markets
- At least 2 years of supervisory or team lead experience in a managed care or health plan setting
- Strong knowledge of CMS SNP Model of Care and Medicare Managed Care Plans
- Experience with utilization review criteria (e.g., MCG guidelines)
- Comfortable navigating EHR systems and healthcare technology platforms
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
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