Remote-Manager, Case Management SNP (California RN License Required)
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. As the Manager, Case Management – SNP, you will oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members. You will ensure compliance with CMS Model of Care requirements while driving quality, efficiency, and member-centered outcomes.
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, Medicare Advantage regulations, Care coordination and population health strategies
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
- 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
Responsibilities
- 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), 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, 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
Benefits
- Competitive compensation and benefits package
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Associate degree
