Manager Case Management

My Health; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Join a forward-thinking organization as the Manager of Case Management within clinical operations. You will lead the case management team, ensuring high-quality care coordination for members with complex needs while collaborating to enhance the overall member experience. This full-time role offers competitive compensation, full benefits, and the opportunity to make a significant impact in healthcare management.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• 5 years of clinical case management experience required.
• 2+ years in a supervisory or leadership role.
• Active RN license required.

Responsibilities

• Lead and supervise a team of case managers and care coordinators.
• Oversee compliance with NCQA, URAC, CMS, and state regulations.
• Collaborate with departments to improve care coordination.

Skills

Population health management

Chronic condition management

Communication skills

Leadership skills

Organizational skills

Education

Bachelor’s degree in Nursing, Social Work, or related field

Master’s degree

Tools

MCG

Tableau

Epic

Salesforce

Job description

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My Health is excited to announce a new Manager of Case Management position within our clinical operations team!

The Manager of Case Management is responsible for leading the case management team in providing high-quality, cost-effective, and member-centered care coordination. This role oversees the day-to-day operations of case management activities for high-risk, high-cost, and complex members, ensuring compliance with regulatory requirements and company standards. The manager collaborates across departments to improve outcomes, reduce unnecessary utilization, and enhance the member experience.

Essential Duties and Responsibilities:

• Supervise a team of case managers, care coordinators, and support staff
• Monitor caseloads, clinical documentation, and engagement performance metrics
• Review and approve care plans and clinical interventions for appropriateness and effectiveness
• Oversee timely member outreach, goal setting, and reassessment cycles
• Ensure compliance with NCQA, URAC, CMS, and state-specific regulations
• Collaborate with UM, analytics, HR, and provider relations to ensure care coordination alignment
• Conduct case rounds, staff development sessions, and performance reviews
• Lead audit preparation and corrective action planning for case management
• Maintain up-to-date policies, procedures, and workflows
• Provide clinical support and guidance for escalated or complex member cases
• Other duties assigned

Qualifications:

• Education: Bachelor’s degree in Nursing, Social Work, or related field required; Master’s degree preferred
• Licensure: Active RN license required (must be licensed in states where members reside or obtain multistate license); CCM preferred
• Experience: Minimum 5 years of clinical case management experience; 2+ years in a supervisory or leadership role

Skills:

• Strong understanding of population health and chronic condition management
• Excellent organizational, communication, and team leadership skills
• Proficient in case management platforms and reporting tools (e.g., MCG, Tableau, Epic, Salesforce)
• Remote
• Full-time, Monday through Friday schedule with potential flexibility based on audit and compliance needs.
• Occasional travel may be required for accreditation, audits, or training purposes.

Why Join My Health:

• Be part of a forward-thinking organization that is transforming utilization and case management with concierge-level services.
• Work in an innovative environment that values compliance, quality, and patient-centered care.
• Opportunity to play a key role in achieving regulatory excellence and operational efficiency.

My Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management

• Industries

  Insurance, Hospitals and Health Care, and Nursing Homes and Residential Care Facilities

Referrals increase your chances of interviewing at My Health by 2x

Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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