Care Coordinator Manager

On-Site Manager of Care Coordination - Livingston, NJ (4 days on-site/1 day remote)

Must have Active RN or LCSW licensure in NJ

The Manager of Care Coordination is a working manager role, with approximately 40% of time dedicated to direct care coordination activities and 60% to team supervision and management as well as program leadership and strategy. Reporting to the Associate Chief Medical Officer, the Manager leads Vanova Health's care coordination program through a period of meaningful growth and transformation — elevating current workflows, onboarding new population health technology, expanding services across the CIN, and building the external relationships necessary to support effective transitions of care.

The ideal candidate is equally comfortable working alongside their team as they are setting direction, influencing stakeholders, and driving program-wide change.

• Conduct and oversee Transitional Care Management (TCM) outreach and follow-up for patients discharged from acute and post-acute settings.
• Carry an active caseload focused on high-risk, high-utilizing, and complex patients.
• Collaborate closely with PCPs, specialists, behavioral health clinicians, and social workers to develop care plans and ensure they are informed by the treating team and effectively executed.

• Partner with the Associate Chief Medical Officer to assess current operations and define a strategic vision for program growth and improvement, including but not limited to the following areas:
• Lead a comprehensive review of TCM and complex care management workflows; identify gaps and develop refined protocols, training, and implementation plans.
• Develop and implement a strategy for identifying and managing high-cost, high-utilizing patients, including through risk stratification, proactive outreach, and individualized care planning.
• Develop and advance a comprehensive behavioral health strategy — expanding internal roles, strengthening partnerships with external providers, and identifying and implementing integrated care models and interventions.
• Develop a social work strategy that moves beyond reactive referral management — using population health data, SDOH screening, and risk stratification to deploy social work resources intentionally toward patients with the greatest intervenable need.
• Establish and maintain a KPI framework that reflects team performance, patient outcomes, and program impact; use data to drive continuous improvement and inform strategic decisions.
• Drive expansion of care coordination services to additional CIN practices, building the relationships, workflows, and infrastructure needed for successful onboarding and execution.
• Recruit, onboard, supervise, and evaluate Care Coordinators, Care Coordination Specialists, Behavioral Health Specialists, Social Workers, and other staff.
• Assess baseline team knowledge and develop plans to address skill gaps, standardize practice, and expand clinical scope.
• Champion a patient-centered team culture through modeling, training, and accountability.
• Provide ongoing coaching, performance feedback, and professional development.
• Manage staffing levels, scheduling, and workload distribution to ensure adequate coverage and team sustainability.

• Lead the onboarding, and optimization of a new population health platform (e.g., Arcadia, Innovacer) in partnership with clinical, IT, data leadership and teams.
• Use population health tools to monitor ADT data, identify care gaps, stratify risk, and drive targeted interventions.
• Compile and present performance reports to leadership on TCM, ED…