Manager, Case Management – RN License Required

Jobtailor; Deutschland; Vor Ort; EUR 78.967 - 105.290; Vollzeit

Zusammenfassung

Jobtailor seeks an experienced RN to lead an integrated care management team for Medicare Advantage SNP members, ensuring CMS Model of Care compliance, high quality outcomes and efficient operations.

The role focuses on coaching a high-performing team, timely Health Risk Assessments and Care Plans, and cross-functional collaboration with Utilization Management, Quality Improvement and clinical operations to advance population health strategies.

Qualifikationen

• Active, unrestricted California RN license.
• Minimum 5 years of clinical case management experience.
• Minimum 1 year of SNP program experience.
• Willingness to obtain RN licensure in additional markets, if needed.
• Strong understanding of CMS SNP Model of Care.
• Medicare Advantage regulations.
• Care coordination and population health strategies.

Aufgaben

• 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.

Kenntnisse

Case management leadership

CMS SNP Model of Care

Care coordination

Population health strategies

Quality improvement

Team coaching

Ausbildung

Associate's or Bachelor’s Degree in Nursing

Jobbeschreibung

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