Care Manager Jobs

About The Position

Requirements

• 3+ years in case management, care coordination, digital health coaching or similar with at least 1–2 years in a lead or supervisory capacity.
• Working knowledge of HEDIS measures, comfort translating measure specifications into operational protocols.
• Experience managing or mentoring front-line care teams in a metrics-driven environment.
• Strong analytical instincts: able to read a member cohort dashboard, identify outliers, and translate the finding into a concrete team action.
• Excellent written and verbal communication — can write a clear outreach script and also present trend data to a health plan partner.

Nice To Haves

• Experience in a digital health or health tech company where you operated at the intersection of technology product and human care delivery.
• RN, LPN, LSW, or CHW credential, or equivalent clinical/community health background.
• Experience with care management platforms, CRM tools, or health plan quality reporting systems.

Responsibilities

• Synthesize member data from the Wellth app highlight engine, Member Care Queues, supplemental data feeds (pharmacy, lab, claims), and partner health plan sources into a unified, advocate-ready view.
• Define and maintain the data standards and intake processes that ensure every member's current measure status, PDC calculation, and outreach history are current before advocates make contact.
• Partner with Product and Engineering to surface actionable signals through the Member Care Queue interface rather than requiring advocates to manually navigate raw data.
• Operate and refine Wellth's cohort segmentation model, assigning members to tiers ranging from digitally self-sufficient to advocate-forward based on engagement history, measure gaps, and clinical risk.
• Translate PDC-clock mathematics and HEDIS measure timelines into calendar-driven prioritization — ensuring advocates always work the highest-impact members first within each measurement year window.
• Own the priority scoring formula and escalation thresholds; adjust parameters in response to real-world close rates and changing plan priorities.
• Identify and flag members in advocate-forward measures (particularly FUM/FUH follow-up after behavioral health discharge and TRC transitions of care) where the MCA call is the entry point — not the fallback.
• Monitor aggregate performance across priority HEDIS measures detect cohort-level or geography-level anomalies before they become measure-year liabilities.
• Flag emerging clinical trends: low preventive screening rates in specific markets, rising rates of uncontrolled diabetes or medication adherence.
• Collaborate with the Quality team to translate trend findings into program adjustments — new journey logic, revised outreach scripts, or escalation rule changes — and track whether interventions close the identified gaps.
• Surface insights to internal leadership and plan partners in a format that connects member-level activity to measure projections.
• Lead the MCA team's daily execution against Member Care Queues — ensuring advocates reach the right member, through the right channel, with the right message, within each measure's action window.
• Enforce the one-outreach-per-7-day consolidation rule and manage exception protocols for members in acute transitions (post-discharge, recent diagnosis, medication change).
• Develop and maintain outreach scripts, decision trees, and escalation guides for each HEDIS measure journey, keeping them current with regulatory updates and real-world advocate feedback.
• Personally carry a caseload of complex or high-priority members — remaining connected to front-line complexity while modeling the standard for the team.
• Hire, onboard, and develop a team of Member Care Advocates, building a culture of accountability, clinical curiosity, and member-centered communication.
• Conduct regular one-on-ones, call reviews, and performance coaching; design scorecards that measure both activity (contacts, completions) and outcomes (measure closures, member re-engagement).
• Build career pathways for advocates interested in deeper clinical or analytical roles as the MCA function matures.
• Serve as the primary internal point of contact for cross-functional teams — Product, Engineering, Quality, and Client Success — on all matters related to MCA workflow, tooling, and capacity planning.

Benefits

• Flexible working arrangements, supporting strong remote-first practices and tools with the option to work in our excellent gathering space in Marina Del Rey.
• Robust paid time off and generous parental leave program.
• Competitive salary & equity structure.
• Health, dental, vision insurance, and FSA/HSA plans.
• Ability to have a positive impact on people who need it most.
• Support of a highly dedicated team focused on building the future of healthcare.