Manager, Case Management

verawholehealth; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Vera Whole Health in the United States seeks a Case Management Manager to lead a multidisciplinary care management team, guiding Value Based Care initiatives and improving clinical outcomes.

This role provides strategic leadership for case management, care coordination, transitional care, and population health programs, aiming to optimize quality, utilization, and patient satisfaction across the continuum of care.

Qualifications

• Experience leading multidisciplinary care teams in value-based care settings.
• Strong data analysis to identify opportunities for improved outcomes and efficiency.
• Ability to oversee clinical programs and drive quality and utilization improvements.
• Excellent communication and collaboration with providers, staff, and partners.
• Leadership with strategic thinking and change management skills.

Responsibilities

• Manage day-to-day operations of Value Based Care clinical programs to improve quality, patient outcomes, and operational efficiency.
• Analyze utilization and population health data to identify opportunities for improved outpatient management and reduced inpatient and ED utilization.
• Develop, implement, and monitor population health initiatives for Value Based beneficiaries.
• Provide oversight and guidance for high-risk patient case management activities with a focus on reducing preventable ED visits, hospital admissions, and readmissions.
• Supervise and support the multidisciplinary care team, including Case Managers, Social Services staff, ED Follow-Up Coordinators, Care Coordinators, and Transitional Care Management Nurses.
• Ensure effective transitions of care for patients discharged from hospitals, SNFs, rehabilitation centers, and behavioral health facilities by coordinating follow-ups, referrals, home health, DME, and community resources.
• Monitor and address quality measure performance and care gaps to support organizational quality goals.
• Develop and facilitate Value Based Care education and training programs for patients, providers, and staff.

Skills

Leadership

Data analysis

Communication

Strategic thinking

Collaboration

Problem solving

Operational excellence

Job description

Job Description Summary

Summary

The Case Management Manager is responsible for overseeing the daily operations of a multidisciplinary care management team that supports and advances Value Based Care initiatives. This role provides leadership and operational oversight for case management, care coordination, transitional care management, emergency department follow-up, population health programs, and continuity of care activities. The Case Management Manager promotes high-quality, cost-effective patient care while driving improvements in clinical outcomes, utilization management, quality performance, and patient satisfaction. This position requires strong leadership, strategic thinking, and collaboration skills, with the ability to leverage internal and external resources to achieve organizational goals and improve healthcare delivery across the continuum of care.

How will you make an impact & Requirements

Essential Duties and Responsibilities

Includes the following. Other duties may be assigned.

• Manage the day-to-day operations of Value Based Care clinical programs to improve quality, patient outcomes, and operational efficiency.
• Analyze utilization and population health data to identify opportunities for improved outpatient management and reduced inpatient and emergency department utilization.
• Develop, implement, and monitor population health initiatives for Value Based beneficiaries.
• Provide oversight and guidance for high-risk patient case management activities with a focus on reducing preventable emergency department visits, hospital admissions, and readmissions.
• Supervise and support the multidisciplinary care team, including Case Managers, Social Services staff, Emergency Department Follow-Up Coordinators, Care Coordinators, and Transitional Care Management Nurses.
• Ensure effective transitions of care for patients discharged from hospitals, skilled nursing facilities, rehabilitation centers, and behavioural health facilities by coordinating:
  • Primary Care Provider follow-up appointments
  • Specialist referrals
  • Home Health services
  • Durable Medical Equipment (DME)
  • Community resource and social service support
• Monitor and address quality measure performance and care gaps to support organizational quality goals.
• Develop and facilitate Value Based Care education and training programs for patients, providers, and staff.
• Participate in quality improvement committees, provider meetings, hospital operational meetings, and other organizational initiatives as required.
• Monitor organizational strategies and performance metrics to support clinical, operational, financial, and utilization management goals.
• Lead the successful integration of Value Based Care programs into existing workflows and operational processes.
• Build and maintain collaborative relationships with providers, community partners, hospitals, post-acute facilities, and other key stakeholders.
• Identify and implement process improvement opportunities that align with organizational objectives and strategic initiatives.
• Travel to provider offices, care teams, and organizational sites as needed to provide education, support, and program oversight.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Analysis and Problem Assessment Ability to gather, analyze, and interpret data to identify trends, gaps, root causes, and opportunities for improvement.
• Compassion Demonstrates empathy, respect, and commitment to patient-centered care while maintaining confidentiality and professional standards.
• Compliance Maintains knowledge of and adheres to all organizational policies, regulatory requirements, compliance standards, and the Code of Conduct.
• Communication Communicates clearly and effectively in verbal and written formats. Demonstrates strong listening skills and adapts communication style to various audiences.
• Dependability Consistently meets deadlines, commitments, attendance expectations, and operational responsibilities while maintaining accountability for results.
• Leadership and Influence Motivates, coaches, and develops team members while promoting collaboration, accountability, and continuous improvement.
• Innovation Identifies creative solutions and opportunities to improve workflows, patient outcomes, and operational effectiveness.
• Integrity Demonstrates honesty, professionalism, ethical decision-making, and adherence to organizational values.
• Judgment and Problem Solving Makes informed, timely decisions by evaluating relevant information, identifying risks, and addressing issues proactively.
• Performance Management Establishes clear expectations, provides feedback and coaching, supports staff development, and evaluates performance effectively.
• Organizational Awareness Understands organizational priorities, operations, culture, and stakeholder relationships to achieve strategic objectives.
• Patient Service Orientation Promotes exceptional patient experiences through