Manager, Case Management

Job Summary

We are seeking an experienced and dedicated Manager of Case Management to lead our case management team. The successful candidate will be responsible for overseeing the coordination and delivery of comprehensive services to our clients/members, ensuring high-quality, cost-effective outcomes while promoting well-being and independence. This role involves direct supervision of case managers, policy implementation, and collaboration with interdisciplinary teams and community partners.

This individual must have:

• Health plan experience and familiarity with managed care operations.
• Experience in delegated case management services within an MSO or similar environment.
• Understanding of NCQA requirements for case management, disease management, and quality assurance programs.

Essential Duties and Responsibilities

• Program Management & Operations: Oversee day-to-day operations of the case management department, including case assignments, monitoring caseloads, and ensuring efficient service delivery.
• Supervision & Leadership: Supervise, mentor, and train case managers and support staff, fostering a collaborative and professional work environment.
• Policy & Compliance: Develop, implement, and enforce policies and procedures to ensure compliance with all federal, state, local, and organizational standards and regulations, including NCQA requirements.
• Quality Assurance: Monitor and analyze case management data and outcomes to identify areas for improvement and implement changes to enhance quality and effectiveness of services.
• Collaboration & Advocacy: Work closely with other departments, community organizations, healthcare providers, and stakeholders to ensure holistic client care and advocate for clients' needs and rights.
• Documentation & Reporting: Ensure all client records, documentation, and reports are accurate, detailed, and submitted in a timely manner using electronic case management systems.
• Crisis Intervention: Provide guidance and support for staff in crisis situations, ensuring client safety and stability.
• Resource Management: Manage the department budget and resources effectively, implementing cost-saving actions where possible.

Qualifications and Skills

Education:

• Bachelor’s degree in Social Work, Nursing, Healthcare Administration, or related field required; Master’s degree preferred.

Experience:

• Minimum of 2–3 years of experience in case management or a related field.
• Minimum of 2–3 years in a supervisory or management role.
• Health plan experience and delegated case management experience required.
• Experience in specialized settings (e.g., acute care, mental health, home health) highly desirable.

Certifications/Licenses:

• Current Registered Nurse (RN) license in the state of Florida required.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.

Skills:

• Strong leadership, people management, and problem-solving abilities.
• Excellent verbal and written communication and interpersonal skills.
• Strong organizational skills and ability to manage multiple priorities in a fast-paced environment.
• Proficiency in case management software and Microsoft Office Suite.
• Deep knowledge of community resources, payer requirements, and NCQA standards for case and disease management.
• Empathy, cultural competence, and a client-centered approach to care.

Pay: From $25.00 per hour

Expected hours: 40.0 per week

Experience:

• NCQA standards: 1 year (Required)
• HEDIS: 1 year (Required)

License/Certification:

• RN License (Required)

Work Location: In person

Salary : $25