Certified Case Manager

Leading strategic initiatives for the Generations Advantage and USFHP lines of business, the full-time remote Clinical Program Manager will design, implement, and oversee programs that improve care transitions, reduce readmissions, and enhance post-discharge follow-up while ensuring compliance with regulatory requirements. Key responsibilities Supports program development activities, including operational reporting and program resources Streamlines case management workflows to eliminate clinical inefficiencies and improve member engagement Monitors program benchmarks and key performance indicators (KPIs) to measure the success of the Clinical Management Program Required qualifications Bachelor's Degree in Health Science, Nursing, or a related field required; Master's degree preferred Certified Case Manager (CCM) or American Case Management Association (ACMA) certification preferred 10 years of experience in healthcare, including managed care, with a focus on Program Management Experience in evaluating financial and clinical performance metrics required Demonstrated experience with NCQA case management accreditation standards and HEDIS quality metrics required