Care Management Leader – High-Risk Patient Care

Astrana Health, Inc.; Rhode Island; On-site; USD 100,000 - 150,000; Full time

Job summary

Astrana Health, Inc. is seeking a Manager, Care Management to support the Health Services Outpatient Care Management team in Rhode Island. This role leads telephonic and in-home care management for high-risk patients to prevent unnecessary utilization and improve outcomes.

The successful candidate will oversee a multidisciplinary clinical team, including providers, nurses, social workers, and care coordinators, while advancing value-based care and ensuring regulatory compliance.

Qualifications

• Bachelor's degree in Nursing or related field.
• Licensed in Rhode Island; Massachusetts RN license preferred.
• At least 3 years of care management and/or utilization management experience.
• Experience leading cross-functional teams and supervising staff.
• Strong written and verbal communication; proficient with Microsoft Office.

Responsibilities

• Manage clinical services, including oversight of policies, procedures, and daily activities of clinical staff.
• Ensure adequate staffing to conduct care management activities and distribute workloads.
• Train staff to serve the population and engage individuals with various disabilities.
• Train Integrated Clinical Services staff on NCQA and HEDIS measures to maintain compliance.
• Ensure compliance with state and federal regulations, including HIPAA.
• Coordinate with other business units to manage emergency policies and processes.

Skills

People leadership

Communication

Attention to detail

Time management

Education

Bachelor's degree in Nursing or related field

Tools

Microsoft Office Suite

Job description

Astrana Health, Inc. is seeking a Manager, Care Management to support the Health Services Outpatient Care Management team in Rhode Island. This role leads telephonic and in-home care management for high-risk patients to prevent unnecessary utilization and improve outcomes.

The successful candidate will oversee a multidisciplinary clinical team, including providers, nurses, social workers, and care coordinators, while advancing value-based care and ensuring regulatory compliance.