This role leads nursing and care management operations for a healthcare services team, supporting members with complex medical and behavioral health needs. The work centers on coordinating utilization management, case management, and care transitions across multiple service lines, with a strong focus on quality, compliance, and team performance.
Key Responsibilities
- Conduct daily oversight of nursing and healthcare services workflows for care management activities.
- Coordinate case management, utilization management, and transitions of care for members with complex needs.
- Provide clinical guidance to staff on care planning, documentation, and escalation of member issues.
- Participate in performance management, staffing support, and operational problem-solving for the team.
- Use health plan processes and systems to monitor service delivery, compliance, and quality outcomes.
- Collaborate with multidisciplinary internal teams to support member care coordination.
Required
- Active RN license.
- Clinical nursing experience in healthcare services, care management, or a related setting.
- Experience supervising or managing staff in a clinical environment.