Manager, Case Management

Job Description Summary The Case Management Manager is responsible for overseeing the daily operations of a multidisciplinary care management team that supports and advances Value Based Care initiatives. This role provides leadership and operational oversight for case management, care coordination, transitional care management, emergency department follow-up, population health programs, and continuity of care activities. The Case Management Manager promotes high-quality, cost-effective patient care while driving improvements in clinical outcomes, utilization management, quality performance, and patient satisfaction. This position requires strong leadership, strategic thinking, and collaboration skills, with the ability to leverage internal and external resources to achieve organizational goals and improve healthcare delivery across the continuum of care. How will you make an impact & Requirements Essential Duties and Responsibilities Includes the following. Other duties may be assigned. Manage the day-to-day operations of Value Based Care clinical programs to improve quality, patient outcomes, and operational efficiency. Analyze utilization and population health data to identify opportunities for improved outpatient management and reduced inpatient and emergency department utilization. Develop, implement, and monitor population health initiatives for Value Based beneficiaries. Provide oversight and guidance for high-risk patient case management activities with a focus on reducing preventable emergency department visits, hospital admissions, and readmissions. Supervise and support the multidisciplinary care team, including Case Managers, Social Services staff, Emergency Department Follow-Up Coordinators, Care Coordinators, and Transitional Care Management Nurses. Ensure effective transitions of care for patients discharged from hospitals, skilled nursing facilities, rehabilitation centers, and behavioral health facilities by coordinating: Primary Care Provider follow-up appointments Specialist referrals Home Health services Durable Medical Equipment (DME) Community resource and social service support Monitor and address quality measure performance and care gaps to support organizational quality goals. Develop and facilitate Value Based Care education and training programs for patients, providers, and staff. Participate in quality improvement committees, provider meetings, hospital operational meetings, and other organizational initiatives as required. Monitor organizational strategies and performance metrics to support clinical, operational, financial, and utilization management goals. Lead the successful integration of Value Based Care programs into existing workflows and operational processes. Build and maintain collaborative relationships with providers, community partners, hospitals, post-acute facilities, and other key stakeholders. Identify and implement process improvement opportunities that align with organizational objectives and strategic initiatives. Travel to provider offices, care teams, and organizational sites as needed to provide education, support, and program oversight. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Analysis and Problem Assessment Ability to gather, analyze, and interpret data to identify trends, gaps, root causes, and opportunities for improvement. Compassion Demonstrates empathy, respect, and commitment to patient-centered care while maintaining confidentiality and professional standards. Compliance Maintains knowledge of and adheres to all organizational policies, regulatory requirements, compliance standards, and the Code of Conduct. Communication Communicates clearly and effectively in verbal and written formats. Demonstrates strong listening skills and adapts communication style to various audiences. Dependability Consistently meets deadlines, commitments, attendance expectations, and operational responsibilities while maintaining accountability for results. Leadership and Influence Motivates, coaches, and develops team members while promoting collaboration, accountability, and continuous improvement. Innovation Identifies creative solutions and opportunities to improve workflows, patient outcomes, and operational effectiveness. Integrity Demonstrates honesty, professionalism, ethical decision-making, and adherence to organizational values. Judgment and Problem Solving Makes informed, timely decisions by evaluating relevant information, identifying risks, and addressing issues proactively. Performance Management Establishes clear expectations, provides feedback and coaching, supports staff development, and evaluates performance effectively. Organizational Awareness Understands organizational priorities, operations, culture, and stakeholder relationships to achieve strategic objectives. Patient Service Orientation Promotes exceptional patient experiences through proactive engagement, advocacy, responsiveness, and effective problem resolution. Planning and Organization Prioritizes workload, allocates resources effectively, and manages multiple initiatives to achieve desired outcomes. Results Orientation and Execution Demonstrates accountability for achieving departmental and organizational goals while driving measurable outcomes. Teamwork and Collaboration Works effectively across departments and disciplines, fostering positive relationships and shared accountability for success. Work Standards Maintains high standards of performance and professionalism while encouraging excellence within the team. Qualifications To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Education and Experience Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field preferred. Minimum of three to five years of clinical care management, population health, utilization management, or Value Based Care experience preferred. Prior leadership or supervisory experience preferred. Equivalent combinations of education and experience may be considered. Language Skills Ability to read, analyze, interpret, and communicate complex healthcare information. Ability to effectively address sensitive inquiries from patients, providers, staff, and business partners. Mathematical Skills Ability to apply basic mathematical concepts and interpret healthcare utilization and performance data. Reasoning Ability Ability to identify problems, evaluate information, develop solutions, and make sound decisions in complex situations. Computer Skills Proficiency with Electronic Medical Records (EMR), preferably Athena. Proficient with Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint. Experience utilizing population health, reporting, and care management platforms preferred. Certificates, Licenses, and Registrations Current Registered Nurse (RN) license in good standing. Case Management Certification (CCM, ACM, or equivalent) preferred. Valid driver's license and reliable transportation, if travel is required. Physical Demands The physical demands described are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made for qualified individuals with disabilities. While performing the duties of this position, the employee is regularly required to sit, stand, walk, communicate, and use hands to operate office equipment and technology. Occasional bending, reaching, stooping, and lifting of up to 10 pounds may be required. Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment The work environment characteristics described are representative of those encountered while performing the essential functions of this position. Reasonable accommodations may be made for qualified individuals with disabilities. Work is primarily performed in a professional office and healthcare setting. The employee may occasionally travel between provider offices, hospital, or other care locations. The work environment is generally moderate in noise level and may involve interaction with patients, providers, interdisciplinary teams, and community partners. The position may require flexibility in scheduling to meet operational and organizational needs. Compensation Range Compensation Range: $93,675.00 to $140,513.00 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs. Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. Learn More about Mosaic Health Learn More about Millennium Physician Group Learn More about CareMore Health Learn More about Castlight Health Learn More about Vera Whole Health #J-18808-Ljbffr Millennium Healthcare Management Serv LLC