Remote-Manager, Case Management SNP (California RN License Required)

Alignment Health•Remote CA Outside Bay Area, AZ

7d•$113,332 - $169,999•Remote

About The Position

The Remote - Manager, Case Management SNP is responsible for the health care management and coordination of care for members with complex and chronic care needs. Assures compliance with SNP program requirements as outlined in the Model of Care. Monitors activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members. Monitors and reports program performance, including vendor performance monitoring if activities are delegated. This position is responsible for the day-to-day operational performance of an integrated health management team while ensuring high-quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business. This is an exciting opportunity to lead meaningful work that directly impacts vulnerable populations while helping shape innovative care management strategies in a growing organization. If you are passionate about member advocacy, operational excellence, regulatory compliance, and developing strong clinical teams — we would love to hear from you.

Requirements

Active, unrestricted California RN license
Associate’s or Bachelor’s Degree in Nursing
Minimum 5 years of clinical case management experience
Minimum 1 year of experience supporting SNP programs within a health plan environment
Willingness to obtain RN licensure in additional company markets, if needed
Strong understanding of CMS SNP Model of Care
Strong understanding of Medicare Advantage regulations
Strong understanding of Care coordination and population health strategies
Strong leadership and team development capabilities
Excellent communication and relationship-building skills
Data-driven mindset with the ability to analyze trends and drive performance
Experience working with EHR systems and healthcare technology platforms
Strong organizational, project management, and problem-solving abilities
Ability to thrive in a fast-paced, collaborative, remote environment

Nice To Haves

BSN or MSN
2+ years of leadership or supervisory experience in managed care or health plan operations
Case Management certification (CCM, ACM, or equivalent)
Experience with utilization review criteria such as MCG guidelines

Responsibilities

Oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members.
Ensure compliance with CMS Model of Care requirements while driving quality, efficiency, and member-centered outcomes.
Lead, coach, and develop a high-performing case management team serving SNP members.
Ensure timely completion of Health Risk Assessments (Initial & Reassessments), Individualized Care Plans (ICPs), and Interdisciplinary Care Team (ICT) activities.
Monitor operational and quality performance metrics and implement improvement strategies.
Oversee regulatory audits, compliance initiatives, and quality assurance activities.
Collaborate cross-functionally with Utilization Management, HEDIS/STARS, Quality Improvement, and Provider and Clinical Operations teams.
Analyze reporting trends and operational data to support strategic decision-making.
Promote a culture of accountability, collaboration, and continuous improvement.
Support program growth and operational excellence within the Medicare Advantage SNP population.