Manager, Clinical Care Management

EmblemHealth; New York (NY); On-site; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth is seeking a Clinical Leadership role to provide oversight of Care Managers and Community Health Workers serving members with complex medical, behavioral health, and social needs. You will direct daily care management operations, distribute caseloads, optimize workflows, ensure timely documentation, and maintain regulatory compliance.

The ideal candidate has a NY State RN license, 5–8+ years of clinical experience, CCM certification preferred, and strong analytical and communication

Qualifications

• Bachelor’s degree required, preferably in Nursing.
• Current New York State RN license required.
• CCM certification preferred.
• 5–8+ years of clinical experience (Required).
• Experience leading care management teams (Required).
• Detail oriented; strong analytical and problem-solving skills; ability to execute on strategy (Required).
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types of audiences (Required).
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) (Required).

Responsibilities

• Provide clinical leadership and oversight to Care Managers and Community Health Workers serving members with complex medical, behavioral health, and social needs.
• Direct daily care management operations, including caseload distribution, workflow optimization, timely documentation, and management of high-risk, high-cost populations.
• Utilize data to monitor team member and program performance and deploy strategies to improve program efficiency and effectiveness.
• Ensure compliance with NCQA, CMS, state, accreditation, and organizational standards.
• Collaborate with utilization management, behavioral health, pharmacy, quality, and provider teams.

Skills

Communication

Analytical ability

Problem solving

MS Office

Education

Bachelor’s degree

Tools

MS Office

N/A

Job description

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com .

Need Assistance Applying? EmblemHealth provides reasonable accommodations to individuals with disabilities throughout the application and hiring process. If you need an accommodation, please contact [e-mail] so we can support your request in accordance with applicable law.

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Provide clinical leadership and oversight to Care Managers and Community Health Workers serving members with complex medical, behavioral health, and social needs.Ensure delivery of evidence-based, member-centered, whole-person care that addresses physical health, behavioral health, and social determinants of health.Direct daily care management operations, including caseload distribution, workflow optimization, timely documentation, and management of high-risk, high-cost populations.Utilize quality, outcome, productivity, and service-level data to evaluate performance, address operational barriers, and improve program effectiveness and efficiency.Maintain regulatory and accreditation compliance while collaborating across clinical and operational teams to advance quality, member experience, and cost-of-care outcomes.

Principal Accountabilities

• Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards; implement, deploy, and reinforce strategies to improve performance.
• Provide regular case consultation, clinical supervision, and mentoring to team members to ensure clinical rigor, productivity, and address performance-related issues.
• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards.
• Ensure that team members are managing enrollees across the care continuum, inclusive of behavioral health, so that enrollees have access to needed care and services.
• Provide clinical oversight and direction to Care Managers and Community Health Workers supporting members with complex medical, behavioral health, and social needs.
• Ensure delivery of evidence-based, member-centered care management interventions.
• Support appropriate stratification and management of high-risk, high-cost populations.
• Monitor clinical decision-making for consistency with health plan policies, regulatory requirements, and professional standards.
• Ensure timely completion of assessments, care plans, outreach activities, and documentation.
• Utilize data to monitor team member and program performance, including quality, outcomes, productivity, and service levels, and deploy strategies to improve program efficiency and effectiveness.
• Identify operational barriers and implement process improvements.
• Collaborate with utilization management, behavioral health, pharmacy, quality, and provider teams.
• Train employees in process operations; act as a preceptor to newly hired staff.
• Monitor employees’ performance regularly and coach employees as needed.
• Ensure compliance with NCQA, CMS, state, accreditation, and organizational standards.
• Participate in audits, quality reviews, and corrective action plans.
• Monitor adherence to care management programs, policies, and documentation requirements.
• Support quality improvement initiatives focused on clinical outcomes, member experience, and cost of care.
• Serve as a clinical resource; attend Care Management rounds.
• Perform other related tasks as directed or required.

Qualifications

• Bachelor’s degree required, preferably in Nursing
• Current New York State RN license required
• CCM certification preferred
• 5 – 8+ years of clinical experience (Required)
• Health plan experience (Preferred)
• Experience leading care management teams (Required)
• Detail oriented; strong analytical and problem-solving skills; ability to execute on strategy (Required)
• Ability to organize, prioritize, and effectively manage multiple tasks with competing priority levels and deadlines (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) (Required)
• Able to analyze problems and recommend and deploy strategies to improve performance in collaboration with the leadership team (Required)

Additional Information

• Requisition ID: 1000003453
• Hiring Range: $77,760-$149,040

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.