Mgr-Care Management Performance Optimization (Full-time Remote, North Carolina Based)

Alliance Health•Durham, NC

3d•$91,192 - $116,270•Remote

About The Position

The Manager - Care Management Performance Optimization drives operational alignment and leads performance and optimization initiatives across the Care Management department. The role identifies performance gaps, streamlines processes, enhances service delivery, and executes cross-functional projects to improve quality, cost-efficiency, and member satisfaction. This is a full-time remote position. The selected candidate must reside in North Carolina and be willing to travel to the home office in Morrisville, North Carolina, for onsite team meetings as needed.

Requirements

Bachelor’s degree in Nursing, Healthcare Administration, Human Services, Public Health, Business Administration, Data Analytics, or a related field from an accredited college or university, and five years of experience in health care operations, care management, or population health, including at least three years in performance improvement, transformation, or project management; alternatively, a relevant master’s degree and three years of experience in health care operations, care management, or population health, including at least two years in performance improvement, transformation, or project management.
Lean Six Sigma Green Belt (LSSGB) certification required within one year of hire.
Experience with clinical systems and care management platforms.
Strong analytical and data interpretation skills.
Strong verbal and written communication skills.
Strong organizational, project management, and change leadership skills.
Ability to analyze facts, evaluate policies, and devise solutions to problems related to program effectiveness.
Knowledge of healthcare regulations, value-based care, and care management models.
Proficiency with Microsoft Office products and knowledge of data analytics programs and reporting.
Must reside in North Carolina and be willing to travel to the Morrisville, North Carolina, home office for onsite team meetings as needed.

Nice To Haves

Certified Case Manager (CCM) certification preferred.

Responsibilities

Monitor, analyze, and report on care management KPIs.
Collaborate with care management leadership and others to develop performance dashboards and reporting tools.
Identify performance gaps and lead root cause analysis and action planning.
Improve care management business processes by enhancing operational efficiencies.
Develop and maintain standardized care management workflows and documentation practices.
Support care management leadership with projects targeting high-priority care management operations.
Implement Lean Six Sigma or similar process improvement models and methodologies to reduce costs, improve quality, and enhance member experience.
Manage initiatives and workstreams that streamline workflows, reduce administrative burden, and improve member outcomes.
Support change management initiatives and care management-specific operational projects to ensure effective adoption of new processes or technologies.
Act as a liaison within the Care Management department and across cross-functional areas to drive process improvement initiatives aligned with organizational business goals and targets.
Lead and/or participate in interdisciplinary committees or workgroups as determined by leadership.
Ensure high standards of care and support services are delivered in compliance with regulatory, contractual, and legal requirements and obligations.
Contribute to long-term care management strategy through data insights and performance trends.
Facilitate collaboration between internal and external stakeholders to identify strategic partnerships for program initiatives and requirements.
Generate and present reports, dashboards, and ad hoc analyses to communicate performance, findings, and recommendations to leadership and other stakeholders.
Serve as a subject matter expert on care management operations and best practices.
Collaborate with leadership to align operational goals with overall strategic objectives.
Perform other duties as assigned.
Work with Human Resources to attract, maintain, and retain a highly qualified and well-trained workforce.
Ensure staff are trained in and comply with organization, department, and oversight agency policies, procedures, and business processes.
Organize workflows and ensure staff understand their roles and responsibilities.
Ensure the department has the tools and resources needed to achieve organizational goals, support employees, and comply with licensure, regulatory, and accreditation requirements.
Establish and promote a positive, diverse, and inclusive working environment that builds trust.
Ensure all staff are treated with respect and dignity and that standards are transparent, consistent, impartial, and ethical.
Work to resolve conflicts and disputes, ensuring that all participants are given a voice.
Set performance goals and deadlines in line with organizational goals and vision.
Communicate feedback effectively, provide ongoing coaching and mentoring, support a learning environment, and advance team skills and professional development.
Cultivate and encourage cross-team collaboration and partnership.