Medicare Care Management Manager (RN)

Central California Alliance for Health; California; Hybrid; USD 112,000 - 198,000; Full time

Job summary

Join a leading healthcare organization as a Medicare Care Management Manager (RN). You will oversee a team, manage care processes, and ensure effective program evaluation. This role requires strong leadership, clinical knowledge, and a passion for empowering members to achieve their health goals.

Benefits

Medical, Dental, and Vision Plans

Paid Time Off

12 Paid Holidays

401(a) Retirement Plan

457 Deferred Compensation Plan

Health and Wellness Programs

Onsite EV Charging Stations

Qualifications

• 6 years of experience in a health plan or patient care setting.
• 2 years supervising and training a multidisciplinary team.
• 1 year in case management.

Responsibilities

• Plans, organizes, manages, and leads the Care Management Medicare team.
• Provides management oversight related to the Care Management Medicare Unit.
• Collaborates with a variety of Alliance staff on special projects.

Skills

Clinical Nursing

Case Management

Supervision

Care Management

Education

Bachelor's degree in Nursing

Job description

Medicare Care Management Manager (RN)

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

We have an opportunity to join the Alliance as the Medicare Care Management Manager (RN) in the Care Management Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Care Management Director, this position:

1. Plans, organizes, manages, and leads the Care Management Medicare team, acts as a subject matter expert, and provides guidance related to care management activities.
2. Provides management oversight related to the Care Management Medicare Unit functions and departmental operations.
3. Performs program effectiveness evaluation.
4. Manages, supervises, mentors, and trains assigned staff.
5. Collaborates with a variety of Alliance staff on special projects.

ABOUT THE TEAM

Our mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers.

We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here.

1. Knowledge of:
   • The principles and practices of clinical nursing.
   • The principles and practices of case management.
   • The principles and practices of supervision and training.
   • Care management and coordination.
   • Medi-Cal and related policy and benefits-related Title 22 regulations.
   • Medicare D-SNP and related regulations.
   • Concepts and guidelines related to managed care and prepaid healthcare.
2. Ability to:
   • Analyze and interpret legal, regulatory, and contractual language, policies, procedures and guidelines, and legislative and regulatory directives.
   • Train, mentor, supervise, and evaluate the work of staff, promote teamwork, and motivate staff to achieve goals and objectives.
   • Act as a technical resource and explain regulations, processes, and programs related to area of assignment.
   • Organize and prioritize the work of others, delegate effectively, and follow up on work assignments.
   • Provide leadership and facilitate meetings.
   • Plan, organize, and lead data collection activities.
   • Present statistical and technical care management data clearly, utilizing visual aids.
3. Education and Experience:
   • Current and unrestricted license as a Registered Nurse issued by the state of California.
   • Bachelor's degree in Nursing.
   • Six years of experience in a health plan or patient care setting, including at least two years supervising and training a multidisciplinary team, one year in case management, and some experience in care management (a Master's degree may substitute for two years of experience). An equivalent combination of education and experience may also qualify.

OTHER INFORMATION

• Hybrid work environment; interviews will be conducted remotely via Microsoft Teams.
• Attendance at quarterly company-wide events or department meetings is expected, with some positions requiring in-office presence based on business needs.

COMPENSATION

The full compensation range varies by location:

• Zone 1 (Monterey, San Benito, Santa Cruz): $123,399 - $197,454 USD
• Zone 2 (Mariposa, Merced): $112,289 - $179,670 USD

OUR BENEFITS

Available to all regular employees working more than 30 hours/week, with some benefits pro-rated for part-time staff. Benefits unavailable to temporary employees.

• Medical, Dental, and Vision Plans
• Paid Time Off
• 12 Paid Holidays
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Health and Wellness Programs
• Onsite EV Charging Stations

ABOUT US

We are a dedicated team of over 500 employees committed to providing accessible, quality healthcare. Join us at Central California Alliance for Health, where our culture is respectful, diverse, and empowering. We serve members across multiple counties and are an equal opportunity employer. We do not currently provide sponsorship; applicants must be authorized to work in the U.S. full-time.