Seeking a leader in RN Care Management to lead a team of 3 managers and 47 Clinicians. The leader in RN Care Management is responsible for ensuring contract and regulatory compliance for the delivery of integrated care management, care coordination, and utilization management for their Medicare and Medicaid eligible members. The leader in RN Care Management provides the management expertise for achieving the goals and objectives of the program in accordance with the mission of the organization. The core responsibilities can be divided into the following categories:
Provides oversight for program management and ensures clinical integration across providers, Long Term Services and Supports (LTSS) and other community-based programs.
Collaborates with the Product Team as needed and supports strategic planning initiatives based on ongoing product evaluation and feedback from EOHHS and CMS regulators.
Oversight of quality management and program evaluation activities, including contract requirements related to quality improvement projects, corrective action plans, and critical incident follow-up.
Supports performance management initiatives, including manages toward established targets based on key performance indicators (KPIs) and implements improvement strategies as needed.
Collaborates with peers and other THP stakeholders as needed to advance organizational initiatives and support the mission and values of the organization.
Health Plan experience
10 years of clinical practice
5+ years of case management experience in a Managed Care environment is required.
5+ years of progressive management experience in healthcare or insurance plan setting required
Salary $140,000 to $150,000 with a 7.5% bonus
Remote option available a few times a week
Relocation Assistance is available