Care Management Clinical Lead, Fee for Service

OpenKrill; EE. UU.; A distancia; USD 110.000 - 120.000; Jornada completa

Descripción de la vacante

Diverge Health is seeking a Care Management Clinical Lead, Fee for Service to guide end-to-end fee-for-service care management—from care planning and medication reconciliation to documentation and billing. You’ll support health centers evaluating partnerships, onboard new sites, and serve as the operational expert for the delivery team as the program scales.

You will bring an RN license in good standing and 5–10 years in fee-for-service chronic care management, with hands-on experience across

Formación

• RN license in good standing or equivalent clinical licensure.
• 5–10 years of experience in fee-for-service chronic care management, transitions of care, or advanced primary care with hands-on workflow across care plans, reconciliation, EMR documentation, and billing.
• Experience working with Federally Qualified Health Centers (FQHCs) or similar community‑based settings.
• Demonstrated ability to trace billing issues to documentation or process steps, not just flag the issue.
• Comfort fielding state-specific and payer-specific questions from health center staff.

Responsabilidades

• Support health centers during pitches by answering detailed clinical and billing questions.
• Own onboarding of newly signed health centers in partnership with Practice Liaisons.
• Serve as the subject matter expert for the fee-for-service care management team day-to-day.

Conocimientos

RN License

Billing Knowledge

Clinical workflow

Descripción del empleo

At Diverge Health we are passionate about improving health access and outcomes for those most in need. We partner with primary care providers to improve the engagement and management of their Medicaid patients, offering independent practices with specialized resources and clinical programs to close gaps in care. Our teams work to address medical, social and behavioral patient needs, lowering healthcare costs and improving patient lives. Guided by our core values of humility, continuous learning and feeling the weight, our team is on a mission to strengthen communities from within, unlocking people's ability to live their healthiest lives.

We are seeking a Care Management Clinical Lead, Fee for Service to join our team! In this role, you will be the hands‑on expert who understands our fee for service care management work end to end, from care planning and medication reconciliation through documentation and billing. You will support health centers as they decide whether to partner with us, guide them through onboarding, and be the go‑to resource for our delivery team as this work scales.

What you'll do

As Care Management Clinical Lead, Fee for Service, you will play a pivotal role in making sure our fee for service care management work is grounded in real, hands‑on expertise at every stage, from the first conversation with a health center to the claim that gets billed.

Key areas you'll add value

• Support Practice Liaisons during health center pitches by answering the detailed clinical and billing questions that come up as centers decide whether to sign on.
• Own onboarding of newly signed health centers in partnership with Practice Liaisons, translating the fee for service model into the practical steps a center's staff need to get started.
• Serve as the tactical subject matter expert for the team delivering fee for service care management day to day, answering real time questions grounded in hands on experience with the work.
• Be the point of contact when health centers hit billing issues, tracing the problem back to its root cause in documentation or workflow rather than treating it as a standalone billing error.
• Build and maintain the frequently asked questions and training materials that let the broader team, and eventually health center staff themselves, answer more of these questions without you.
• Scale your expertise across the fee for service portfolio as it grows, training the trainers so one person's knowledge becomes the whole team's capability.

What you'll bring

• Registered Nurse (RN) license in good standing, or equivalent clinical licensure
• 5 to 10 years of experience in fee for service chronic care management, transitions of care, or advanced primary care, including hands‑on experience across the full workflow: care plan development, medication reconciliation, EMR documentation, and billing.
• Experience working within or supporting Federally Qualified Health Centers (FQHCs) or similar community‑based healthcare settings.
• Demonstrated ability to trace a billing issue back to the documentation or process step that caused it, not just flag that it happened.
• Comfort fielding detailed, state specific and payer specific questions from health center staff who are still deciding whether to sign on.

Preferred Experience

• Certification in Case Management (CCM), APCM, ToC and CoCM
• Experience training or onboarding new staff or partner organizations on a clinical workflow.
• Familiarity with value‑based care models and population health strategies.

Who we're looking for

• Closer to the work than to managing people, energized by being the go‑to expert rather than a supervisor.
• Patient and precise when explaining complex clinical and billing logic to people encountering it for the first time.
• Comfortable being pulled into sales conversations, onboarding, and troubleshooting, sometimes all in the same week.
• Builds trust with health center staff by having real answers, not just process pointers.
• A strong representative of Diverge Health's mission, vision, and values in every interaction and every deliverable.

This is a full‑time, exempt, salaried position. Commensurate on candidate experience, the expected base salary range for this role is $110,000 - $120,000.

Our Investors

Diverge Health is funded by GV and incubated by Triple Aim Partners, which since 2019 has partnered with entrepreneurs to co‑found and launch eight companies focused on improving the quality, experience and total cost of healthcare.

At Diverge Health we believe that a diverse set of backgrounds and experiences enrich our teams and enable us to realize our mission. If you do not have experience in all areas detailed above, we encourage you to share your unique background with us and how it might be additive to our team.

Special Considerations

Diverge Health is dedicated to the principles of Diversity, Equity and Inclusion and Equal Employment Opportunities for all employees and applicants for employment. We do not discriminate on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, reproductive health decisions, family responsibilities or any other characteristic protected by the federal, state or local laws. Our decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance and business needs.

At this time, we are unable to support hiring in Alaska and Hawaii due to our primary operations being based in the Eastern and Central time zones.

Candidates must be authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.