Manager, Case Management (RN)

Internal Title: ECM Clinical Manager

Department: Enhanced Care Management (ECM)

Location: Remote with up to 25% travel - must be based in one of the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Nevada, North Carolina, Oregon, Texas, and Washington.

The ECM Clinical Manager is responsible for clinical oversight and management of ECM staff to address the client's medical and behavioral health needs and social determinants of health. The ECM Clinical Manager will communicate directly with ECM staff and occasionally with patients via telephone, telehealth, or during Interdisciplinary Care Team meetings (as needed) to discuss medication management/adherence, ensure appropriate follow-up with Primary Care Provider, Behavioral Health Provider, and other specialist(s). They will guide any crises encountered by ECM staff. The ECM Clinical Manager will collaborate with the client’s broader care team (PCP, BH clinicians, etc.) to provide client advocacy, ensure that the clients receive needed services, and measure progress toward the goals outlined in their patient-centered individualized care plan. The ECM Clinical Manager will monitor team progress and coach staff to succeed and manage performance where needed.

Supervise a team of approximately 10-15 direct reports under the ECM team to ensure high-quality enrollments and care management services. The exact number of direct reports may fluctuate based on business needs.

Oversee client outreach, enrollments, and the creation of Individual Care Plans, assessing if clients' needs can be managed by an ECM Lead Care Manager; serve as an escalation point when necessary.

Drive the team to meet key performance indicators (KPIs) effectively.

Collaborate with the Director(s) of Enhanced Care Management to implement changes and process improvements.

Provide clinical oversight approximately 30% of the time, including, but not limited to: supervision of clinical staff, clinical sign-offs, oversight of care plans, leading IDT meetings, and serving as a clinical consultant for complex clinical cases.