Manager of Care Management

Astrana Health, Inc.•Johnston, RI

3d•$100,000 - $150,000•Hybrid

About The Position

We are currently seeking a highly motivated Manager, Care Management to support our Health Services Outpatient Care Management team at Astrana Health. This role is responsible for managing telephonic and in-home Care Management services and activities for high-risk patients, with the primary goal of preventing unnecessary utilization and improving patient outcomes. This position will lead a multidisciplinary clinical team, including providers, registered nurses, social workers, community health workers, and care coordinators. The ideal candidate is a strong people leader with deep care management expertise, a passion for serving complex patient populations, and a commitment to advancing value-based care.

Requirements

Bachelor's degree in Nursing or a related field, or graduation from an accredited School of Nursing
Licensed in Rhode Island; additional Massachusetts RN license preferred
At least 3 years of care management and/or utilization management experience
In-depth knowledge of assessment, diagnosis, and treatment of individuals with complex needs
Strong understanding of care management, mental health community resources, and local healthcare delivery systems
Experience leading a functional area, managing cross-functional teams on large-scale projects, or providing direct supervisory leadership, including hiring, training, work assignment, and performance management
Effective written and verbal communication skills
Extensive experience with Microsoft Office Suite, including Word, Excel, and PowerPoint
Professional work ethic and strong attention to detail
Ability to thrive in a fast-paced environment
Authentic passion for improving the lives of complex, high-risk patients and advancing value-based care
Active RN, LMSW/LCSW, LMFT, LPC, PhD, or PsyD license in the applicable state
Rhode Island licensure required
Independent licensure required

Nice To Haves

Massachusetts RN license
Experience supporting integrated care management programs for high-risk populations
Experience working within managed care, health plan, or value-based care environments

Responsibilities

Manage clinical services, including oversight of clinical policies, procedures, and daily activities of clinical team staff
Ensure adequate staffing to conduct care management activities and effectively distribute workloads
Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities, including chronic physical and behavioral health conditions
Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to maintain compliance
Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA
Ensure compliance with emergency management policies, procedures, and processes by serving as a liaison with other business units
Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for patients
Ensure appropriate care planning, education, and interventions are conducted for members identified as at risk
Ensure staff coordinate the exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members
Monitor data to address quality measures, trends, and improvement opportunities, including provider issues, service gaps, and patient needs
Evaluate the effectiveness of care management programs and implement adjustments when opportunities for improvement are identified