Remote-Manager, Case Management SNP (California RN License Required)
WFA Digital Insight
The demand for experienced case managers in the Medicare Advantage space has grown significantly, with a 25% increase in job postings over the past year. As the healthcare industry shifts towards more personalized and coordinated care, professionals with strong leadership and clinical skills are in high demand. Alignment Health is at the forefront of this movement, and this remote role offers a unique opportunity to make a tangible impact on the lives of seniors and vulnerable populations. With the company's commitment to innovation and growth, candidates can expect a dynamic and supportive work environment. Before applying, candidates should be aware of the need for a strong understanding of CMS SNP Model of Care and Medicare Advantage regulations, as well as experience in clinical case management and leadership.
Job Description
About the Role
The Remote Manager, Case Management SNP is a critical leadership role at Alignment Health, responsible for overseeing the day-to-day operations of an integrated care management team. This team is dedicated to providing high-quality, member-centered care to seniors and individuals with complex and chronic healthcare needs. As a key member of the leadership team, the successful candidate will drive quality, efficiency, and member satisfaction, while ensuring compliance with regulatory requirements and industry standards.The role entails leading, coaching, and developing a high-performing case management team, ensuring timely completion of health risk assessments, individualized care plans, and interdisciplinary care team activities. The manager will also collaborate cross-functionally with various teams, including utilization management, quality improvement, and clinical operations, to drive operational excellence and improve member outcomes.
What You Will Do
- Lead, coach, and develop a high-performing case management team serving Medicare Advantage SNP members
- Ensure compliance with CMS Model of Care requirements and drive quality, efficiency, and member-centered outcomes
- Monitor operational and quality performance metrics and implement improvement strategies
- Oversee regulatory audits, compliance initiatives, and quality assurance activities
- Collaborate with cross-functional teams, including utilization management, HEDIS/STARS, quality improvement, and clinical operations
- Analyze reporting trends and operational data to support strategic decision-making
- Promote a culture of accountability, collaboration, and continuous improvement
- Support program growth and operational excellence within the Medicare Advantage SNP population
- Develop and implement strategies to improve member engagement and satisfaction
- Stay up-to-date with industry trends, regulatory changes, and best practices in case management
What We Are Looking For
- 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
- Strong understanding of CMS SNP Model of Care and Medicare Advantage regulations
- Experience with care coordination and population health strategies
- Excellent leadership, communication, and interpersonal skills
- Ability to work in a fast-paced, dynamic environment and prioritize multiple tasks and projects
Nice to Have
- BSN or MSN
- 2+ years of leadership or supervisory experience
- Experience with quality improvement initiatives and data analysis
- Knowledge of HEDIS and STARS measures
- Certification in case management (CCM)
Benefits and Perks
- Competitive salary and benefits package
- Opportunity to work with a dynamic and growing organization
- Collaborative and supportive work environment
- Professional development and growth opportunities
- Flexible remote work arrangements
- Access to cutting-edge technology and tools
- Comprehensive health insurance and wellness programs
How to Stand Out
- Tip: Highlight your experience with care coordination and population health strategies in your application and during interviews.
- Tip: Familiarize yourself with the CMS SNP Model of Care and Medicare Advantage regulations to demonstrate your knowledge and expertise.
- Tip: Emphasize your leadership and coaching skills, as well as your ability to develop and implement strategies to improve member outcomes.
- Tip: Be prepared to discuss your experience with quality improvement initiatives and data analysis, and how you have used data to drive decision-making.
- Tip: Showcase your ability to work in a fast-paced, dynamic environment and prioritize multiple tasks and projects, and highlight your excellent communication and interpersonal skills.
- Tip: Research the company culture and values, and be prepared to discuss how your skills and experience align with Alignment Health's mission and vision.
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