Manager of care management, population health

Job Requirements

Directs and oversees the day-to-day operations, clinical practice, and performance of the ambulatory care management team(s). Ensures the delivery of high-quality, patient-centered case management services through effective assessment, care planning, care coordination, utilization management, and transitions of care. Leads the development and implementation of operational, quality, and population health initiatives that promote positive patient outcomes, regulatory compliance, health equity, and effective resource utilization. Responsible for staffing, performance management, professional development, budgeting, and process improvement activities while fostering a culture of collaboration, accountability, and continuous improvement. Partners with organizational leaders, physicians, and interdisciplinary teams to advance care management strategies and support organizational goals.

Direct and oversee the daily operations of one or more Ambulatory care management teams to ensure the effective delivery of assessment, care planning, care coordination, utilization management, and transitions of care services.

Lead, develop, and manage care management staff through recruitment, onboarding, scheduling, performance evaluation, competency assessment, coaching, and performance management processes.

Establish and monitor department performance goals, productivity standards, and key performance indicators to support quality, operational, financial, and patient outcome objectives.

Ensure compliance with regulatory, accreditation, payer, and organizational requirements, including case management standards of practice, documentation expectations, and quality measures.

Develop, implement, and evaluate care management programs, workflows, and initiatives designed to improve population health outcomes, resource utilization, patient experience, and value-based care performance.

Lead quality improvement and patient safety initiatives by analyzing operational and clinical performance data, identifying opportunities for improvement, and implementing corrective actions.

Promote health equity and address social determinants of health through strategies that improve access to care, reduce barriers, and support optimal patient outcomes.

Manage departmental resources and budgetary performance through effective staffing, workload management, and oversight of operational expenditures.

Collaborate with physicians, nursing leaders, operational leaders, community partners, and interdisciplinary teams to advance care management strategies and achieve organizational goals.

Represent care management services in departmental, organizational, and system committees, strategic initiatives, accreditation activities, and professional development programs.

Work Experience

Education & Experience - Required

• Bachelor's degree in Nursing or Master's degree in Nursing, Health Administration, Public Health, or a related healthcare field.
• Seven (7) years of progressive care management, case management, utilization management, care coordination, or related healthcare experience. Five (5) years accepted if job start date prior to 2027.
• Two (2) years of previous experience with staff supervision, performance management, operational oversight, project leadership, or program management.
• Current Maryland unrestricted licensure as a Registered Nurse (RN) or Physical Therapist (PT).
• Experience in Population Health or an Accountable Care Organization highly desirable.

Education & Experience – Preferred

• Current care management certification such as Accredited Case Manager (ACM), Certified Case Manager (CCM), Certified Managed Care Nurse (CMCN), or other relevant specialty certification.
• Lean, Six Sigma, Project Management, or other quality/performance improvement certification.
• Previous leadership experience in care management, utilization management, population health, or a related healthcare setting.
• Previous experience leading quality improvement, regulatory compliance, or operational excellence initiatives.
• Active participation in professional organizations, committees, or healthcare leadership activities.