Manager, CM (RN)
Core
Manages the care management team and oversees healthcare outcomes for 28 million members, ensuring compliance with federal, state, and NCQA standards.
Role type
Senior IC care management manager
Builds
High-quality, cost-effective healthcare programs and member care processes
Domain
Healthcare / Managed Care
Required skills
Care management program oversight, regulatory compliance (federal/state/NCQA), team leadership, escalation management, data reporting, policy development, member/provider outreach coordination
Preferred skills
Utilization management (UM) experience, care management (CM) experience
Technologies
None explicitly stated
Responsibilities
Oversee and review care management documentation for compliance, manage processes for complex case escalations, set goals and objectives for the care management team, monitor audits to ensure regulatory compliance, provide feedback to improve member and provider experience, assist senior leadership with hiring and training
Seniority
Senior, hands-on IC
