Manager of Case Management (RN Required)

Palo Verde Community College District; San Diego (CA); Hybrid; USD 120,000 - 160,000; Full time

Job summary

Palo Verde Community College District in California is seeking an executive RN leader to design and implement a network-wide Care Management program in a value-based environment. You will build teams, develop workflows, and partner with health centers, health plans, and internal stakeholders to improve quality, utilization, and patient outcomes in FQHC and Medi-Cal contexts.

This role blends strategic leadership with hands-on execution, leveraging data, care coordination, and risk-based

Qualifications

• Active RN license.
• 5+ years of clinical experience; 6+ years preferred.
• Experience leading clinical or care management teams.
• Strong interpersonal, communication, and collaboration skills.

Responsibilities

• Lead and develop a network-wide care management program aligned to risk-based contracts.
• Oversee care coordination across health plans and centers.
• Use data (HEDIS/Arcadia) to drive performance and improve outcomes.
• Support health equity initiatives and address social determinants of health.
• Provide clinical guidance on coding and documentation audits.
• Collaborate with MSO and health centers on utilization management.

Skills

RN leadership

Population health

Data-driven decision making

Cross-functional collaboration

Quality improvement

Tools

Arcadia

Job description

Lead and build a high-impact Care Management program in a value-based environment.

We’re hiring a hands‑on RN leader to build and lead a network‑wide Care Management program within a clinically integrated network operating in value-based, risk-driven models.

This is not a traditional case management role. We are looking for a leader who can develop strategy, build strong teams, and drive measurable improvements in quality, utilization, and patient outcomes—particularly within FQHC and Medi-Cal populations.

In this role, you will partner closely with health centers, health plans, and internal stakeholders to design and implement scalable care management strategies that address health disparities, improve performance, and support success in risk-based contracts.

Who we are looking for:

• Experience leading care management or case management teams (RNs/LVNs or interdisciplinary staff)
• Background in value-based care or risk-based contract environments
• Experience working with FQHC, Medi-Cal, or underserved populations
• Demonstrated ability to build or scale care management or population health programs
• Comfortable using data (HEDIS, Arcadia, or similar tools) to drive decision-making
• Able to operate both strategically and hands‑on when needed
• Strong collaborator who works effectively across teams and stakeholders

What You’ll Do:

Leadership & Program Development

• Lead and develop a team of care managers (RNs/LVNs) and health care liaisons
• Build and execute a network‑wide Care Management program aligned to risk-based contracts
• Develop workflows, tools, and processes to ensure program success and scalability
• Serve as a clinical resource and subject matter expert to member health centers

Care Management & Clinical Oversight

• Identify at‑risk populations and coordinate care to improve outcomes and control costs
• Oversee care coordination across health plans and health centers
• Ensure delivery of care that is safe, timely, effective, efficient, and patient‑centered
• Support whole‑person care through comprehensive assessments and care plan development

Quality Improvement & Data-Driven Performance

• Use payer and Arcadia reports to identify performance gaps and implement action plans
• Drive improvement in quality metrics, access, utilization, and patient outcomes
• Apply performance improvement methodologies (HEDIS, PDSA, etc.)
• Support health equity initiatives and address social determinants of health

Utilization Management

• Partner with MSO and health centers to conduct utilization management reviews
• Analyze utilization patterns (ED/IP) and implement improvement strategies
• Collaborate with payers to design and optimize utilization processes

Coding & Documentation Integrity

• Provide clinical guidance related to coding and documentation audits
• Use audit findings to drive performance improvement and team education

Qualifications Required

• Active RN license
• Minimum 5 years of clinical experience (6+ years preferred)
• Experience leading clinical or care management teams
• Strong interpersonal, communication, and collaboration skills

Preferred

• Experience in value-based care, population health, or utilization management
• Knowledge of Medi-Cal, HEDIS, P4P, and quality improvement methodologies
• Experience with Arcadia or similar care management/data platforms
• CCMC or equivalent certification

Core Competencies

• Clinical leadership and team development
• Program building and operational execution
• Data-driven decision-making and performance management
• Strong accountability and follow-through
• Cross‑functional collaboration and stakeholder engagement
• Critical thinking and problem-solving

Work Environment & Requirements:

• Remote/Hybrid work environment
• Up to 25% travel required
• Flexible schedule (including 9/80 option)

Additional Requirements:

• Must possess a valid driver’s license, active insurance, and reliable transportation for work‑related travel
• Must be able to work occasional evenings and weekends as needed within a 40‑hour workweek