Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.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 RequiredFully Remote | California Preferred (Outside Bay Area Preferred)Full-Time | Monday–FridayMake an Impact in Medicare Advantage CareWe 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 DoAs 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 ResponsibilitiesLead, coach, and develop a high-performing case management team serving SNP membersEnsure timely completion of:Health Risk Assessments (Initial & Reassessments)Individualized Care Plans (ICPs)Interdisciplinary Care Team (ICT) activitiesMonitor operational and quality performance metrics and implement improvement strategiesOversee regulatory audits, compliance initiatives, and quality assurance activitiesCollaborate cross-functionally with:Utilization ManagementHEDIS/STARSQuality ImprovementProvider and Clinical Operations teamsAnalyze reporting trends and operational data to support strategic decision-makingPromote a culture of accountability, collaboration, and continuous improvementSupport program growth and operational excellence within the Medicare Advantage SNP populationWhat You Bring:Required QualificationsActive, unrestricted California RN licenseAssociate’s or Bachelor’s Degree in NursingMinimum 5 years of clinical case management experienceMinimum 1 year of experience supporting SNP programs within a health plan environmentWillingness to obtain RN licensure in additional company markets, if neededStrong understanding of:CMS SNP Model of CareMedicare Advantage regulationsCare coordination and population health strategiesPreferred QualificationsBSN or MSN2+ years of leadership or supervisory experience in managed care or health plan operationsCase Management certification (CCM, ACM, or equivalent)Experience with utilization review criteria such as MCG guidelinesSkills for SuccessStrong leadership and team development capabilitiesExcellent communication and relationship-building skillsData-driven mindset with the ability to analyze trends and drive performanceExperience working with EHR systems and healthcare technology platformsStrong organizational, project management, and problem-solving abilitiesAbility to thrive in a fast-paced, collaborative, remote environmentWhy Join Us?Fully remote flexibilityOpportunity to lead and grow within a rapidly expanding organizationMeaningful work improving outcomes for high-risk Medicare populationsCollaborative, mission-driven culture focused on quality care and innovationAbility to influence and enhance case management programs at scaleCompetitive compensation and benefits packagePhysical RequirementsReasonable 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 conferencingFrequent sitting, standing, typing, and computer useOccasionally lift and/or move up to 10 poundsClose vision and ability to adjust focus required for computer-based workJoin 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 - $169,999.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.About UsAlignment Health is championing a new path in senior care that empowers members to age well and live their most vibrant lives. Our mission-focused team makes high-quality, low-cost care a reality for members every day. Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most.We believe that great work comes from people who are inspired to be their best. We've built a team of people who want to make a difference in the lives of the seniors we serve. Come join the team that is changing health care — one person at a time.
18 days ago