Manager of Care ManagementDepartment: Market Ops - Rhode Island
Employment Type: Full Time
Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919
Reporting To: Robert Millette
Compensation: $100,000 - $150,000 / year
DescriptionAbout the RoleWe 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.
What You'll Do- 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
Qualifications- 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
Preferred Qualifications- 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
Licenses/Certifications- Active RN, LMSW/LCSW, LMFT, LPC, PhD, or PsyD license in the applicable state
- Rhode Island licensure required
- Independent licensure required
Environmental Job Requirements and Working Conditions- This is a full-time position supporting telephonic and in-home Care Management services for high-risk patient populations
- Ability to work in a fast-paced environment while managing multiple priorities and deadlines
- Occasional local travel may be required to support business and patient care needs
- Frequent use of a computer, telephone, and standard office equipment
- Must maintain compliance with all HIPAA, state, and federal regulations
- Ability to work independently and collaboratively across multidisciplinary teams
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.
