Care Management Programs & Operations Lead

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 90,000 - 130,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a dedicated leader to oversee the Care Management area within Medical Management. The role focuses on program development, staff supervision, and ensuring regulatory and contractual compliance across CM initiatives.

Responsibilities include directing work plans, monitoring outcomes, and presenting clinical results. The position requires strong collaboration, analytical skills, and a proven record of developing innovative CM programs for

Qualifications

• Active, unrestricted Rhode Island Nursing or LICSW license; RI license documentation if not current.
• Bachelor's degree in health-related field or Associate degree in Nursing with seven years in supervisory role.
• Five or more years' experience in clinical, managed care and/or operational management.
• Five or more years supervisory experience.
• Strong collaboration, interpersonal and leadership skills.
• Strong oral and written communication skills.
• Strong analytical skills.
• Proven ability to develop innovative programs and services.
• Well-developed organizational and planning skills.
• Ability to independently problem solve.
• Proficient in Microsoft Office.
• Ability to work extended hours including evenings, nights and weekends.

Responsibilities

• Develops, executes and evaluates work plan for area of responsibility.
• Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs.
• Provides regular reports and presentations on clinical outcomes of CM programs.
• Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool.
• Assists with developing case management programs for new lines of business.
• Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables.
• Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions.
• Assist in the training of new staff and providing an environment of continuous learning for existing staff.
• Sets performance standards and productivity measures for direct reports.
• Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development.
• Determines/monitors staffing ratios.
• Develops and ensures consistency in CM documentation standards.
• Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs.
• Manages the development of CM policies and procedures and ensures annual review and revision.
• Collaborate with Chief Medical Officer and Medical Director on new and existing clinical programs.
• Serves as organizational consultant for CM performance practice.
• Participates in administrative budget development and monitoring for area of responsibility.
• Identifies and recommends opportunities for improvement and implements process improvement activities.
• Representative of CM programs with state and community partners.
• Collaborate with Matrix partners to develop, maintain and evaluate programs.
• Other duties as assigned

Skills

Leadership

Analytical skills

Communication skills

Staff supervision

Data analysis

Education

Bachelor's degree in health-related field

Associate degree in Nursing

Master's degree

Certification as a Case Manager

Tools

Microsoft Office

Job description

Neighborhood Health Plan of Rhode Island is seeking a dedicated leader to oversee the Care Management area within Medical Management. The role focuses on program development, staff supervision, and ensuring regulatory and contractual compliance across CM initiatives.

Responsibilities include directing work plans, monitoring outcomes, and presenting clinical results. The position requires strong collaboration, analytical skills, and a proven record of developing innovative CM programs for