Manager, Case Management – RN License Required

Responsibilities

• Oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members
• Ensure compliance with CMS Model of Care requirements
• Drive quality, efficiency, and member-centered outcomes
• Lead, coach, and develop a high-performing case management team
• Ensure timely completion of Health Risk Assessments, Individualized Care Plans, Interdisciplinary Care Team activities
• Monitor operational and quality performance metrics
• Collaborate cross-functionally with Utilization Management, HEDIS/STARS, Quality Improvement, Provider and Clinical Operations teams

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
• California RN license