Manager, Case Management – RN License Required
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Job Description
Manager overseeing high-performing case management team for Medicare Advantage SNP at Alignment Health. Driving compliance and quality care outcomes for members with complex healthcare needs.
Responsibilities:
- Oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members
- Ensure compliance with CMS Model of Care requirements
- Drive quality, efficiency, and member-centered outcomes
- Lead, coach, and develop a high-performing case management team
- Ensure timely completion of Health Risk Assessments, Individualized Care Plans, Interdisciplinary Care Team activities
- Monitor operational and quality performance metrics
- Collaborate cross-functionally with Utilization Management, HEDIS/STARS, Quality Improvement, Provider and Clinical Operations teams
Requirements:
- Active, unrestricted California RN license
- Associate’s or Bachelor’s Degree in Nursing
- Minimum 5 years of clinical case management experience
- Minimum 1 year of experience supporting SNP programs within a health plan environment
- Willingness to obtain RN licensure in additional company markets, if needed
- Strong understanding of CMS SNP Model of Care
- Medicare Advantage regulations
- Care coordination and population health strategies
Benefits:
- Fully remote flexibility
- Opportunity to lead and grow within a rapidly expanding organization
- Meaningful work improving outcomes for high-risk Medicare populations
- Collaborative, mission-driven culture focused on quality care and innovation
- Ability to influence and enhance case management programs at scale
- Competitive compensation and benefits package
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