Manager - Care Management

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

Job summary

Astrana Health, Inc. is hiring a Manager of Care Management to lead the telephonic and in-home care management for high-risk patients in Rhode Island.

Based in Johnston, RI, you will oversee a multidisciplinary team, shape policies, ensure HIPAA compliance, and drive outcomes aligned with value-based care objectives.

The role requires RN licensure in RI, strong leadership, and experience with NCQA/HEDIS measures; travel may be occasional.

Qualifications

• Bachelor's degree in Nursing or a related field or graduation from an accredited School of Nursing.
• Licensed in Rhode Island; additional Massachusetts RN license preferred.
• At least 3 years of care management and/or utilization management experience.
• Deep knowledge of assessment, diagnosis, and treatment of individuals with complex needs.
• Strong understanding of care management, mental health resources, and local delivery systems.
• Experience leading a functional area or cross-functional teams, including supervision and hiring.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint).
• Detail-oriented with ability to thrive in a fast-paced environment.

Responsibilities

• Oversee clinical policies and daily activities of clinical team staff.
• Ensure staffing levels and workload distribution for care management activities.
• Train staff to serve diverse populations, including those with disabilities.
• Train Integrated Clinical Services on NCQA and HEDIS measures to maintain compliance.
• Ensure operations comply with HIPAA and state/federal regulations.
• Coordinate with other units to manage emergency policies and procedures.
• Monitor procedures and outreach efforts for positive patient outcomes.
• Coordinate care planning and interventions for at-risk members.
• Facilitate information exchange between behavioral health and medical providers.
• Monitor data for quality measures, trends, and improvement opportunities.
• Evaluate program effectiveness and implement improvements.

Skills

Leadership

Cross-functional collaboration

Communication

Care management expertise

HIPAA compliance awareness

Analytical thinking

Detail-oriented

Education

Bachelor's degree in Nursing or related field

Rhode Island RN license

Massachusetts RN license preferred

Active RN or related state licenses (LMSW/LCSW/LMFT/LPC/PhD/PsyD)

Tools

Microsoft Office Suite

Job description

Manager - Care Management

Department: Market Ops - Rhode Island

Employment Type: Full Time

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Reporting To: Robert Millette

Compensation: $100,000 - $150,000 / year

Description

About the Role

We are currently seeking a highly motivated Manager, Care Management to support our Health Services Outpatient Care Management team at Astrana Health. This role is responsible for managing telephonic and in-home Care Management services and activities for high-risk patients, with the primary goal of preventing unnecessary utilization and improving patient outcomes.

This position will lead a multidisciplinary clinical team, including providers, registered nurses, social workers, community health workers, and care coordinators. The ideal candidate is a strong people leader with deep care management expertise, a passion for serving complex patient populations, and a commitment to advancing value-based care.

Our Values

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Manage clinical services, including oversight of clinical policies, procedures, and daily activities of clinical team staff
• Ensure adequate staffing to conduct care management activities and effectively distribute workloads
• Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities, including chronic physical and behavioral health conditions
• Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to maintain compliance
• Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA
• Ensure compliance with emergency management policies, procedures, and processes by serving as a liaison with other business units
• Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for patients
• Ensure appropriate care planning, education, and interventions are conducted for members identified as at risk
• Ensure staff coordinate the exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members
• Monitor data to address quality measures, trends, and improvement opportunities, including provider issues, service gaps, and patient needs
• Evaluate the effectiveness of care management programs and implement adjustments when opportunities for improvement are identified

Qualifications

• Bachelor's degree in Nursing or a related field, or graduation from an accredited School of Nursing
• Licensed in Rhode Island; additional Massachusetts RN license preferred
• At least 3 years of care management and/or utilization management experience
• In-depth knowledge of assessment, diagnosis, and treatment of individuals with complex needs
• Strong understanding of care management, mental health community resources, and local healthcare delivery systems
• Experience leading a functional area, managing cross-functional teams on large-scale projects, or providing direct supervisory leadership, including hiring, training, work assignment, and performance management
• Effective written and verbal communication skills
• Extensive experience with Microsoft Office Suite, including Word, Excel, and PowerPoint
• Professional work ethic and strong attention to detail
• Ability to thrive in a fast-paced environment
• Authentic passion for improving the lives of complex, high-risk patients and advancing value-based care

Preferred Qualifications

• Massachusetts RN license
• Experience supporting integrated care management programs for high-risk populations
• Experience working within managed care, health plan, or value-based care environments

Licenses/Certifications

• Active RN, LMSW/LCSW, LMFT, LPC, PhD, or PsyD license in the applicable state
• Rhode Island licensure required

Environmental Job Requirements and Working Conditions

• This is a full-time position supporting telephonic and in-home Care Management services for high-risk patient populations
• Ability to work in a fast-paced environment while managing multiple priorities and deadlines
• Occasional local travel may be required to support business and patient care needs
• Frequent use of a computer, telephone, and standard office equipment
• Must maintain compliance with all HIPAA, state, and federal regulations
• Ability to work independently and collaboratively across multidisciplinary teams
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.