Manager, Large Case Management

Lucent Health Solutions LLC•Nashville, TN

12d

About The Position

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health. Honest Transparent Communication: be open and clear in all interactions without withholding crucial information Integrity: ensure accuracy in reporting, work outputs and any tasks assigned Truthfulness: provide honest feedback and report any issues or challenges as they arise Trustworthiness: build andmaintaintrust by consistentlydemonstratingreliable behavior Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values Accountability: own up to mistakes and take responsibility for rectifying them Respect: treat colleagues, clients and partners with fairness and dignity Confidentiality: safeguard sensitive information and avoid conflicts of interest Hardworking Consistency: meet or exceed deadlines,maintaininghighproductivitylevels Proactiveness: take initiative to tackle challenges without waiting to be asked Willingness: voluntarily offer toassistinadditionalprojects or tasks when needed Adaptability: work efficiently under pressure or in changing environments

Requirements

Registered Nurse with a minimum of 3-5 years of clinical nursing experience.
Minimum of 3 years in a healthcare leadership role (e.g.team lead or higher)
Bachelor’s Degree from an accredited college or university required
Demonstrated ability to manage and lead a team of direct reports
Excellent written and oral communication skills
Strong analytical skills with attention to detail
Ability to identify areas of improvement and develop action plan to address findings
Positive, proactive team-oriented approach/attitude 
Strong knowledge of Microsoft Office products
Holds a current, active, and unrestricted RN license that allows him/her to practice in a state or territory of the United States.

Nice To Haves

Relevant certifications such as Certified Case Manager (CCM) may be preferred.

Responsibilities

Provide strategic and operational leadership for the Large Case Management program, ensuring alignment with organizational goals and clinical best practices.
Oversee daily operations through direct leadership of Supervisors, ensuring productivity, quality, timeliness, and documentation standards are met.
Establish and monitor key performance indicators (KPIs),identifying trends and implementing action plans to improve outcomes and efficiency.
Lead the development and execution of case management strategies for high-cost and complex cases to optimize clinical outcomes and financial impact.
Support Case Management vendor strategy, performance monitoring, and evaluation ofreferral appropriateness and outcomes.
Ensure compliance with all accreditation, regulatory, and contractual requirements (e.g., state, federal, URAC, NCQA, HIPAA).
Partner with Finance and leadership to ensure accuracy, integrity, and insights within stop loss reporting and high-cost claim analysis.
Lead internal and external audits, quality assurance initiatives, and regulatory readiness efforts.
Collaborate cross-functionally with Utilization Management, Claims, Network, and Client Services to drive coordinated care and program effectiveness.
Identify and implement process improvements to enhance quality, efficiency, and scalability of the case management program.
Develop, implement, and maintain policies, procedures, and clinical guidelines for case management operations.
Provide leadership, mentorship, and development for Supervisors and team members, including performance management and career progression planning.
Oversee hiring, onboarding, training, and workforce planning to ensure appropriate staffing and capability development.
Communicate program performance, outcomes, and strategic insights to senior leadership.
Lead and support change management initiatives within scope of responsibility.
Performs other duties as assigned