Mgr-Care Management Performance Optimization (Full-time Remote, North Carolina Based)

The Manager - Care Management Performance Optimization is responsible for driving operational alignment and leading performance and optimization initiatives across the Care Management department. The role focuses on identifying performance gaps, streamlining processes, enhancing service delivery, and executing cross-functional projects to improve quality, cost-efficiency, and member satisfaction.

Performance Management

• →Monitor, analyze, and report on care management KPIs
• →Collaborate with care management leadership and others to develop performance dashboards and reporting tools
• →Identify performance gaps and lead root cause analysis and action planning
• →Improve care management business processes by enhancing operational efficiencies 
• →Develop and maintain standardized care management workflows and documentation practices

Optimization

• →Support CM leadership with projects targeted to address care management high priority operations
• →Implement Lean Six Sigma, or similar process improvement models/methodologies to reduce costs, improve quality and enhance member experience
• →Manage initiatives/workstreams that streamline workflows, reduce administrative burden and improve member outcomes
• →Support change management initiatives and CM specific operational projects to ensure effective adoption of new processes or technologies

Operational Excellence and Compliance

• →Act as the liaison within Care Management department and between cross-functional areas to drive process improvement initiatives aligned with the organization’s business goals and targets
• →Lead and/or participate in interdisciplinary committee or workgroups as determined by leadership
• →Ensure high standards of care and support services are delivered in compliance with regulatory, contractual and legal requirements and obligations 
• →Contribute to long-term care management strategy through data insights and performance trends

Stakeholder Collaboration and Communication

• →Facilitate collaboration between internal and external stakeholders to identify strategic partnerships for the success of program initiatives and requirements
• →Generate and present reports, dashboards and ad-hoc analyses to communicate performance, findings and recommendations to leadership and other stakeholders
• →Serve as a subject matter expert on care management operations and best practices
• →Collaborate with leadership to align operational goals with overall strategic objectives
• →Other duties as assigned

Manage and Develop Staff

• →Work with Human Resources to attract, maintain, and retain a highly qualified and well-trained workforce
• →Ensure staff are well trained in and comply with all organization, department, and oversight agency policies, procedures, and business processes
• →Organize workflows and ensure staff understand their roles and responsibilities
• →Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• →Actively establish and promote a positive, diverse, and inclusive working environment that builds trust 
• →Ensure all staff are treated with respect and dignity
• →Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• →Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• →Set goals for performance and deadlines in line with organization goals and vision
• →Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• →Cultivate and encourage efforts to expand cross-team collaboration and partnership

Education & Experience

Required: 

Bachelor’s degree in Nursing, Healthcare Administration, Human Services, Public Health, Business Administration, Data Analytics, or related field from an accredited college/university and five (5) years of experience in health care operations, care management or population health of which at least  three (3) years of experience in performance improvement, transformation or project management

Or

Master’s degree in Nursing, Healthcare Administration, Human Services, Public Health, Business Administration, Data Analytics, or related field from an accredited college/university and three (3) years of experience in health care operations, care management or population health of which at least two (2) years of experience in performance improvement, transformation or project management.

Lean Six Sigma Green Belt (LSSGB) required within one (1) year of hire.

Preferred: 

Certified Case Manager (CCM) certification preferred.

• Experience with clinical systems and care management platforms
• Strong analytical and data interpretation skills
• Strong verbal and written communication skills
• Strong organizational and project management, and change leadership skills
• Ability to analyze facts, evaluate policies and devise solutions to problems related to program effectiveness
• Knowledge of healthcare regulations, valued-based care, and care management models
• Use of Microsoft Office products and knowledge of data analytics programs and reporting

$91,192-$116,270/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility