Supervisor – Care Management

Provide daily supervision of care management teams and ensure adherence to policies, procedures, and regulatory requirements

Oversee clinical care management services and support staff performance and clinical quality

Implement policies and corrective or disciplinary actions when needed

Monitor and support implementation of the care management process, including training and documentation

Review health plan reports to identify members needing care coordination or targeted interventions

Ensure compliance with NCQA standards, CMS, health plan and state regulations, and internal protocols

Support development and review of individualized care plans

Lead or participate in Multi-Disciplinary Care Team meetings

Coordinate with PCPs, specialists, vendors, Utilisation Management, Inpatient Case Management, and Ambulatory Care

Monitor and evaluate case management plans, treatments, services, and crisis interventions

Conduct internal audits and provide feedback, coaching, and quality improvement support

Assist with health plan audit submission deliverables

Conduct performance evaluations and monitor staff attendance and accountability

Provide mentorship and training; oversee hiring, onboarding, and training of new staff

Maintain staff timekeeping and personnel records

Perform other duties and projects as assigned

• Active RN or LVN unrestricted license required
• Minimum of 3+ years of care management experience in a medical group, IPA, or HMO setting
• Associate Degree of Science in Nursing
• Knowledge of NCQA standards, Model of Care and Case Management requirements, CMS and state regulations, and HMO/ACO model structures
• Strong communication, leadership, and critical thinking skills
• Proven ability to work cross-functionally with clinicians, leadership, and administrative staff to drive outcomes
• Experience in managing diverse teams and leading quality-focused initiatives
• Skilled with Microsoft Office suite and able to learn and navigate other computer systems

Demonstrates expertise in care management, ensuring compliance with NCQA standards, CMS regulations, and effective clinical quality oversight. Proven leadership in managing care teams, implementing policies, and driving quality improvement initiatives.

• Active RN Or LVN License
• Care Management Experience
• Knowledge Of NCQA Standards
• Leadership Skills
• Microsoft Office Suite Proficiency

• Care Management
• Clinical Quality Oversight
• Policy Implementation
• Health Plan Report Review
• Case Management Evaluation
• Individualized Care Plans Development
• Internal Audits
• Performance Evaluations
• Crisis Interventions
• Training And Mentorship

• Strong Communication
• Critical Thinking
• Team Management
• Cross-Functional Collaboration
• Quality-Focused Initiative Leadership

• Active RN Or LVN License
• Associate Degree Of Science In Nursing

• NCQA Standards
• CMS Regulations
• HMO
• ACO
• Model Of Care
• Case Management Requirements
• Utilisation Management
• Inpatient Case Management
• Ambulatory Care
• Multi-Disciplinary Care Team