Manager, Care Management

Moda Health•Portland, OR

6d•Hybrid

About The Position

The Manager of Care Management provides operational and clinical leadership for care management programs, including care coordination, complex case management, and population health initiatives. This role ensures the delivery of high-quality, member-centered care while optimizing clinical outcomes, access, and total cost of care. The Manager serves as a clinical and operational leader, partnering across the organization and with external stakeholders to design, implement, and continuously improve care management strategies aligned with regulatory requirements, quality metrics, and value-based care goals. This is a FT hybrid position based in Portland, Oregon.

Requirements

Bachelor’s degree in Nursing (BSN) or related clinical field required
Minimum of 5 years of clinical or healthcare delivery experience.
At least 3 years of experience in care management, case management, utilization management, or population health—preferably within a health plan.
Minimum of 2–3 years of leadership or supervisory experience.
Active, unrestricted clinical license (RN or other relevant healthcare professional) in the State of Oregon required.
Strong clinical knowledge and application of evidence-based guidelines.
Demonstrated leadership and team development skills.
Experience driving operational and clinical transformation initiatives.
Proficiency in interpreting and leveraging healthcare data and financial metrics.
Strong project management and organizational skills.

Nice To Haves

Master’s degree preferred.

Responsibilities

Collaborate in the development, implementation, evaluation, and continuous improvement of clinical programs to support Moda’s mission, strategic goals, regulatory requirements, and accreditation standards
Lead day-to-day operations of care management programs, including care coordination, case management, and disease management.
Provide coaching, mentorship, and performance management to a multidisciplinary team.
Foster a culture of accountability, continuous improvement, and member-centered care.
Ensure appropriate staffing models, workflow design, and resource allocation to meet program demands.
Serve as a clinical subject matter expert to guide evidence-based care management practices.
Ensure adherence to clinical guidelines, regulatory standards, and accreditation requirements (e.g., CMS, NCQA).
Monitor and improve program performance related to quality outcomes, member experience, and utilization.
Develop and execute care management strategies aligned with organizational goals, including: Value-based care, Population health management, Health equity initiatives
Identify trends in utilization, gaps in care, and opportunities to improve access and outcomes.
Lead quality improvement initiatives and implement action plans to address performance gaps.
Partner with analytics teams to identify data needs and interpret clinical, financial, and operational performance data.
Use data insights to inform program design, decision-making, and resource prioritization.
Oversee reporting of care management outcomes, including dashboards and ad hoc analyses.
Ensure compliance with all applicable state, federal, and contractual requirements.
Oversee accurate and timely documentation and reporting, including submissions to NCQA and other regulatory bodies.
Develop, implement, and maintain departmental policies, procedures, and standard work.
Performs other duties as assigned