Care Manager - SNP (Peak Health)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Care Manager - SNP (Peak Health) based in the United States.

This role provides comprehensive care coordination for members enrolled in Special Needs Plans (SNPs), helping them navigate complex healthcare needs and available benefits.
You will develop individualized care plans, coordinate multidisciplinary support, and serve as a key connection between members, caregivers, providers, and care teams.
The position combines clinical expertise, care management, regulatory knowledge, and strong member advocacy.
You will support members through transitions of care, identify barriers to improved quality of life, and connect them with appropriate healthcare and community resources.
The role also contributes to quality oversight, program development, compliance, and continuous improvement across care management operations.
Success requires strong organization, communication, clinical judgment, and the ability to manage sensitive situations while meeting defined deadlines.
This is a high-visibility opportunity for a registered nurse who is passionate about improving outcomes for complex and vulnerable populations.

Accountabilities:

• Conduct comprehensive intake assessments with members and families and develop individualized care plans that reflect clinical, financial, social, and other relevant circumstances.
• Coordinate care with Interdisciplinary Care Team (ICT) members, primary care providers, specialists, caregivers, and ancillary providers to ensure continuity and appropriate follow-through.
• Serve as the primary care management contact for members and caregivers, helping them understand benefits, access in-network providers, and connect with community resources.
• Support members during transitions of care and conduct virtual face-to-face visits when needed to address coordination and care needs.
• Provide education, resources, and support that strengthen member self-management skills and promote improved health outcomes and quality of life.
• Review and evaluate Health Risk Assessment (HRA) information and other member data to identify needs, barriers, and opportunities for targeted programs and services.
• Manage and triage member self-referrals to appropriate care management programs and collaborate with other care management professionals to coordinate services.
• Participate in care management, case management, and quality committees and contribute to program development, implementation, oversight, and delegation activities.
• Review medical records and documentation as needed, investigate potential quality-of-care concerns, and support initiatives designed to protect member health and safety.
• Contribute to audits, quarterly reporting, and oversight activities while ensuring alignment with CMS SNP Model of Care requirements, NCQA standards, Medicare Advantage regulations, and applicable contractual requirements.
• Identify opportunities to improve care management processes, resources, and member outcomes while maintaining accurate documentation and meeting required deliverables.

Requirements:

• Current Registered Nurse (RN) license in the state where services are provided, or an active multistate RN license through the enhanced Nurse Licensure Compact (eNLC).
• At least 3 years of clinical healthcare experience.
• At least 1 year of experience in care management, case management, or population health.
• Bachelor’s degree in Nursing is preferred; an Associate of Science in Nursing (ASN) degree or nursing diploma is also considered.
• Experience working with Medicare, Medicaid, and/or Special Needs Plan (SNP) populations is preferred.
• At least 1 year of SNP care management experience is preferred.
• Working knowledge of CMS regulatory and contractual requirements, Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.
• Strong written and verbal communication skills, with the ability to collaborate effectively with members, caregivers, providers, and multidisciplinary teams.
• Strong problem-solving and organizational skills, including the ability to manage competing priorities and consistently meet deadlines and deliverables.
• Exceptional attention to detail and the ability to maintain accurate member records and documentation.
• Proficiency with Microsoft Office applications.
• Ability to remain effective and professional in stressful or demanding working conditions.
• Ability to perform the physical requirements of the role, including standing and walking for extended periods, frequent bending or stretching, and lifting or pushing items within the stated limits.

Benefits:

• Full-time, 40-hour-per-week position.
• Remote work arrangement.
• Exempt employment status.
• Opportunity to make a direct impact on the health outcomes and quality of life of SNP members.
• High-visibility role within a medical management and care coordination environment.
• Opportunity to collaborate with interdisciplinary clinical teams, providers, caregivers, and community resources.
• Professional exposure to Medicare Advantage, SNP Model of Care, CMS requirements, and NCQA standards.
• Comprehensive role encompassing clinical care coordination, quality improvement, regulatory compliance, and population health initiatives.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.