Care Management Lead: Clinical Programs & Compliance

MCS Puerto Rico; San Juan (PR); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Restaurant d'entreprise

Job summary

MCS Puerto Rico seeks a Nurse Care Management Supervisor to lead the Care Management Program work plan across our lines of business in Puerto Rico. You will ensure resources, compliance with guidelines, and the development of evidence‑based care management protocols.

This role supervises staff, coordinates referrals for medical, psychosocial, and educational needs, and prepares regulatory reports. A Puerto Rico nursing license and at least three years of clinical program supervision are required.

Qualifications

• Bachelor's degree in Nursing Science required.
• At least 3 years in clinical programs or medical treatment roles.
• Must possess a valid Puerto Rico nursing license.

Responsibilities

• Manage Care Management Program work plan across the different MCS business lines.
• Prepare, review, revise, and maintain updated operational guidelines for Care Management.
• Develop and implement Care Management Policies and Procedures.
• Oversee care management interventions and ensure processes meet regulatory standards.
• Monitor staff activities and coordinate educational/training resources.
• Coordinate referrals to address medical, psychosocial, and educational needs.
• Submit required regulatory reports and ensure external service coordination.
• Lead interdisciplinary case discussions with Providers and Medical Directors.
• Monitor monthly statistics and communicate barriers to program goals.
• Supervise and train personnel to comply with policies and procedures.

Skills

Supervision

Care management

Interdisciplinary collaboration

Regulatory compliance

Education

Bachelor's degree in Nursing Science

Job description

MCS Puerto Rico seeks a Nurse Care Management Supervisor to lead the Care Management Program work plan across our lines of business in Puerto Rico. You will ensure resources, compliance with guidelines, and the development of evidence‑based care management protocols.

This role supervises staff, coordinates referrals for medical, psychosocial, and educational needs, and prepares regulatory reports. A Puerto Rico nursing license and at least three years of clinical program supervision are required.