Care Management Manager - High-Risk Patient Outcomes

Astrana Health Management; Johnston, Northern (RI, KY); Hybrid; USD 100,000 - 150,000; Full time

Job summary

Astrana Health Management is seeking a Manager, Care Management in Johnston, RI to lead telephonic and in-home care coordination for high-risk patients. You will oversee a multidisciplinary team, ensure staffing and training, and drive care planning aligned with value-based care principles.

The ideal candidate holds a nursing license (RI) with 3+ years in care management and strong communication. This role emphasizes compliance, data-driven improvement, and collaboration across clinical teams.

Qualifications

• Bachelor's degree in Nursing or a related field.
• Rhode Island licensure; Massachusetts license preferred.
• At least 3 years of care management or utilization management experience.
• Experience leading cross-functional teams or supervising staff.
• Knowledge of NCQA and HEDIS measures and processes.
• Strong written and verbal communication skills.

Responsibilities

• Manage clinical services, including oversight of policies, procedures, and daily activities of the clinical team.
• Ensure adequate staffing and distribute workloads effectively.
• Train staff to serve populations with disabilities and complex needs.
• Ensure compliance with NCQA/HEDIS measures and HIPAA regulations.
• Maintain compliance with state and federal regulations and coordinate with other units.
• Monitor quality metrics and intervene to close care gaps.
• Coordinate information exchange between behavioral health and medical providers to develop comprehensive care plans.
• Evaluate care management programs and implement improvements as needed.

Skills

Leadership

Communication

Team coordination

Stakeholder management

Education

Bachelor's degree in Nursing or related field

Tools

Microsoft Office Suite

Word

Excel

PowerPoint

Job description

Astrana Health Management is seeking a Manager, Care Management in Johnston, RI to lead telephonic and in-home care coordination for high-risk patients. You will oversee a multidisciplinary team, ensure staffing and training, and drive care planning aligned with value-based care principles.

The ideal candidate holds a nursing license (RI) with 3+ years in care management and strong communication. This role emphasizes compliance, data-driven improvement, and collaboration across clinical teams.