Certified Case Manager

Job Summary

Leading strategic initiatives for the Generations Advantage and USFHP lines of business, the full-time remote Clinical Program Manager will design, implement, and oversee programs that improve care transitions, reduce readmissions, and enhance post-discharge follow-up while ensuring compliance with regulatory requirements.

Key responsibilities

• Supports program development activities, including operational reporting and program resources
• Streamlines case management workflows to eliminate clinical inefficiencies and improve member engagement
• Monitors program benchmarks and key performance indicators (KPIs) to measure the success of the Clinical Management Program

Required qualifications

• Bachelor's Degree in Health Science, Nursing, or a related field required; Master's degree preferred
• Certified Case Manager (CCM) or American Case Management Association (ACMA) certification preferred
• 10 years of experience in healthcare, including managed care, with a focus on Program Management
• Experience in evaluating financial and clinical performance metrics required
• Demonstrated experience with NCQA case management accreditation standards and HEDIS quality metrics required