Manager, Case Management RN- Integrated Care
Core
Oversee Integrated Care Duals Product Teams to coordinate care, services, and health benefits for selected member populations, ensuring safe and effective utilization of healthcare resources and compliance with state/accreditation requirements.
Role type
Senior IC case management manager (nursing/healthcare)
Builds
Member care plans, service coordination, and care transitions for dual-eligible populations
Domain
Healthcare / Managed Care / Medicaid & Medicare
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Case management, team leadership, care plan development, regulatory compliance, data analysis, stakeholder coordination, incident management, policy review, staff mentoring, eligibility verification
Preferred skills
Medicaid/Medicare managed care experience, HCSB Waiver case management, prior management experience
Technologies
Microsoft Outlook, Word, Excel, mobile communication devices (smart phone, iPad), Care Management electronic record systems
Responsibilities
Monitor and promote safe utilization of healthcare resources; manage performance of Care Management teams; audit documentation for accuracy; review member care plans and define interventions; maintain optimal caseload ratios; coordinate services with community partners; investigate member incidents; monitor provider network quality; analyze care management data; update care management policies and SOPs; precept and mentor new staff; conduct member and provider visits
Seniority
Manager, hands-on leadership with team oversight
