About the Role

We 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.

Our Values

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

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.