Medicare Care Management Manager (RN)

Central California Alliance for Health; Merced (CA); On-site; USD 112,000 - 180,000; Full time

Job summary

Join a leading healthcare organization as a Medicare Care Management Manager (RN) in California. You will lead a team, oversee care management activities, and ensure compliance with regulations. This role offers a hybrid work environment and a commitment to empowering healthcare delivery.

Benefits

Medical, Dental, and Vision plans

Paid Time Off and Holidays

Retirement and Deferred Compensation Plans

Health and Wellness Programs

Onsite EV Charging Stations

Qualifications

• Current RN license issued by California.
• Six years of experience in health plan or patient care setting.

Responsibilities

• Plans and leads the Care Management Medicare team.
• Provides management oversight for departmental operations.
• Collaborates with Alliance staff on special projects.

Skills

Clinical Nursing

Case Management

Supervision

Care Management

Regulatory Analysis

Team Leadership

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.
   • Act as a technical resource and explain regulations, processes, and programs.
   • Organize and prioritize work, delegate effectively, and follow up on assignments.
   • Provide leadership and facilitate meetings.
   • Plan and lead data collection activities.
   • Present data clearly using appropriate visual aids.
3. Education and Experience:
   • Current and unrestricted RN license issued by California.
   • Bachelor's degree in Nursing.
   • Six years of experience in a health plan or patient care setting, including at least two years supervising 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 may be required.
• In-office or community presence may be necessary depending on business needs, to be discussed during the interview.

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 for employees working more than 30 hours/week, including:

• Medical, Dental, and Vision plans
• Paid Time Off and Holidays
• Retirement and Deferred Compensation Plans
• 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, professional, and empowering. Learn more through our Fact Sheet.

We are an equal employment opportunity employer and participate in E-Verify. Currently, we do not sponsor visas; applicants must be authorized to work in the U.S. full-time without sponsorship.