About the position

The position involves managing a care management team that supports long-term care members with physical, medical, and behavioral health needs. The role focuses on developing and assessing high-quality, cost-effective healthcare outcomes while ensuring compliance with federal and state regulations. The manager will oversee documentation, implement policies, and guide team members in addressing complex care cases, ultimately aiming to improve member and provider experiences.

Responsibilities

• Manage the care management team serving long-term care members with physical/medical and behavioral/mental health needs.
• Oversee and review required documentation to maintain compliance with regulations and agreements.
• Develop, implement, and oversee long-term care management policies and procedures.
• Assign, monitor, and evaluate work assignments and caseloads of staff based on requirements and member needs.
• Direct daily activities of staff, reviewing and approving caseloads accordingly.
• Manage escalated and complex care cases, providing guidance to team members.
• Perform outreach to assess member needs and collaborate with resources.
• Ensure proper coordination of medical service functions with other departments.
• Develop and oversee long-term care management programs to facilitate appropriate service use.
• Set goals and objectives for the team to achieve cost-effective healthcare results.
• Monitor audits to ensure compliance with regulatory requirements.
• Provide updates and insights on team goals to senior management.
• Review member data to identify trends and improve care quality.
• Coach and guide team members to enhance member and provider experiences.
• Educate the team on key initiatives and facilitate ongoing communication.
• Assist with onboarding, hiring, and training of team members.
• Lead and champion change within the scope of responsibility.

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor's degree with 5+ years of related experience for RN team members.
• Master's degree or Graduate from an Accredited School of Nursing with 5+ years of related experience for BH team members.
• 2+ years supervisory experience preferred.
• Highly advanced clinical knowledge and ability to assess member needs.
• Strong knowledge of healthcare managed care principles preferred.
• Experience working with providers to develop long-term service plans preferred.
• Strong knowledge of medication indications and side effects or BH care management principles preferred.
• Current state's Registered Nurse (RN) license or Licensed Clinical Behavioral Health Professional required upon hire.

Nice-to-haves

• Experience in managing care management teams in a healthcare setting.
• Knowledge of regulatory requirements and industry standards for long-term care management.
• Experience with telephonic and digital outreach methods.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules including remote, hybrid, field, or office work options.