Job DescriptionJob SummaryThe Remote Manager, Continuum of Care provides operational oversight and management for the continuum of care team and care transition programs. This role oversees day-to-day care coordination workflows, evaluates transition processes, and monitors operational performance against quality, cost, and patient experience metrics. The position collaborates with post-acute network partners to support care alignment, reduce avoidable readmissions, and optimize in-network resource utilization in alignment with value-based care objectives.
Essential Functions- Manages day-to-day operations and workflows of care coordination teams to maintain operational compliance and consistent care delivery.
- Directs staff management activities including recruitment, performance evaluations, professional development, coaching, and employee relations.
- Establishes and standardizes standard operating procedures (SOPs), care protocols, and documentation guidelines across care transition workflows.
- Oversees operational relationships and performance monitoring for preferred post-acute provider networks and collaborative partners.
- Evaluates care transition and referral processes to identify operational efficiencies, lower readmission rates, and improve in-network utilization.
- Serves as an escalation point for complex clinical, administrative, or operational issues arising between care coordination staff and external post-acute partners.
- Manages the onboarding, orientation, and ongoing training programs for care coordination staff regarding clinical protocols, regulatory standards, and operational platforms.
- Analyzes care transition metrics and team productivity data to generate operational reports and inform management decisions.
- Coordinates continuous quality improvement initiatives to support organizational efficiency, service delivery, and value-based care goals.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Qualifications- Bachelor's Degree in Nursing, Social Work, Healthcare Administration, or a related field required
- Master's Degree preferred
- A combination of education and relevant experience may be considered in lieu of a degree
- 5-7 years of healthcare experience in clinical care, care coordination, or healthcare operations required
- 2-4 years of supervisory, team lead, or formal direct leadership experience required
- Experience within Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), or value-based care delivery models preferred
- Prior experience coordinating care for high-risk patient populations or managing post-acute network relationships preferred
Knowledge, Skills and Abilities- Demonstrated knowledge of care transitions, utilization management, discharge planning, and post-acute venues of care.
- In-depth knowledge of care coordination practices, discharge planning, utilization management, and post-acute care resources.
- Strong leadership and supervisory skills to direct staff, conduct performance evaluations, and foster team development.
- Analytical and problem-solving skills to interpret operational data, evaluate care transition metrics, and drive process improvements.
- Effective communication skills to collaborate across multidisciplinary teams, leadership, and external healthcare providers.
- Knowledge of value-based care models, healthcare regulatory guidelines, and quality improvement standards.
- Proficiency with enterprise healthcare software, electronic health record (EHR) systems, and office productivity tools.
Licenses and Certifications- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred or
- LCSW- License Clinical Social Worker preferred
- CCM - Certified Case Manager preferred
