Remote-Manager, Case Management SNP (California RN License Required)

The Remote - Manager, Case Management SNP is responsible for the health care management and coordination of care for members with complex and chronic care needs. Assures compliance with SNP program requirements as outlined in the Model of Care. Monitors activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members. Monitors and reports program performance, including vendor performance monitoring if activities are delegated. This position is responsible for the day-to-day operational performance of an integrated health management team while ensuring high-quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business. California RN License Required Fully Remote | California Preferred (Outside Bay Area Preferred) Full-Time | Monday-Friday Make an Impact in Medicare Advantage Care We are looking for an experienced and compassionate healthcare leader to join our team as a Manager, Case Management - Special Needs Plan (SNP). In this fully remote leadership role, you will oversee a high-performing care management team dedicated to improving outcomes for members with complex and chronic healthcare needs. This is an exciting opportunity to lead meaningful work that directly impacts vulnerable populations while helping shape innovative care management strategies in a growing organization. If you are passionate about member advocacy, operational excellence, regulatory compliance, and developing strong clinical teams - we would love to hear from you.

What You'll Do

As the Manager, Case Management - SNP, you will oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members. You will ensure compliance with CMS Model of Care requirements while driving quality, efficiency, and member-centered outcomes.

Key Responsibilities

• Lead, coach, and develop a high-performing case management team serving SNP members
• Ensure timely completion of:
• Health Risk Assessments (Initial & Reassessments)
• Individualized Care Plans (ICPs)
• Interdisciplinary Care Team (ICT) activities
• Monitor operational and quality performance metrics and implement improvement strategies
• Oversee regulatory audits, compliance initiatives, and quality assurance activities
• Collaborate cross-functionally with:
• Utilization Management
• HEDIS/STARS
• Quality Improvement
• Provider and Clinical Operations teams
• Analyze reporting trends and operational data to support strategic decision-making
• Promote a culture of accountability, collaboration, and continuous improvement
• Support program growth and operational excellence within the Medicare Advantage SNP population

What You Bring:

Required Qualifications

• Active, unrestricted California RN license
• Associate's or Bachelor's Degree in Nursing
• Minimum 5 years of clinical case management experience
• Minimum 1 year of experience supporting SNP programs within a health plan environment
• Willingness to obtain RN licensure in additional company markets, if needed
• Strong understanding of:
• CMS SNP Model of Care
• Medicare Advantage regulations
• Care coordination and population health strategies

Preferred Qualifications

• BSN or MSN
• 2+ years of leadership or supervisory experience in managed care or health plan operations
• Case Management certification (CCM, ACM, or equivalent)
• Experience with utilization review criteria such as MCG guidelines

Skills for Success

• Strong leadership and team development capabilities
• Excellent communication and relationship-building skills
• Data-driven mindset with the ability to analyze trends and drive performance
• Experience working with EHR systems and healthcare technology platforms
• Strong organizational, project management, and problem-solving abilities
• Ability to thrive in a fast-paced, collaborative, remote environment

Why Join Us?

• Fully remote flexibility
• Opportunity to lead and grow within a rapidly expanding organization
• Meaningful work improving outcomes for high-risk Medicare populations
• Collaborative, mission-driven culture focused on quality care and innovation
• Ability to influence and enhance case management programs at scale
• Competitive compensation and benefits package

Physical Requirements Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.

• Regularly required to communicate effectively via phone and video conferencing
• Frequent sitting, standing, typing, and computer use
• Occasionally lift and/or move up to 10 pounds
• Close vision and ability to adjust focus required for computer-based work

Join a team that is committed to delivering exceptional care, improving member outcomes, and driving innovation in Medicare Advantage case management. Pay Range: $113,332.00 - $169,999.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Apply tot his job Apply To this Job