Care Management Program Manager

2008

Remote? : 0

Highlights (Bonus, shift, relocation, info for job) :

Job Summary

The Program Manager of Care Management is a core member of the Care Management (CM) program development and operations team and serves as a cross-functional team communicator and collaborator. This role shapes the CM program using the voice of our members and our internal care management team to support, design, and improve our CM programs. This position plays a critical role in standardizing CM processes across all markets, promoting scalability and efficiencies to support quick company growth.

This role works closely with executive and market leadership to develop medical and functional health programs that support AbsoluteCare's mission of delivering integrated care and reducing unnecessary utilization for a vulnerable and chronically complex population. This includes designing, implementing, and measuring outcomes of CM programs across all markets and product lines following health plan, regulatory, and NCQA standards. This position serves as a subject matter expert (SME) for medical CM programs including Chronic Condition and Disease Management, functional health and integration with our Collaborative Care model for behavioral health.

This role serves as the CM liaison for training content development, market leadership support, and communications / marketing. The CM Program Manager creates and maintains internal and external facing relationships with key stakeholders.

This role reviews and analyzes data to identify key stakeholders, process improvements, and program opportunities to support program success. Key performance indicators (KPIs) include reducing potentially preventable events (e.g., ER visits, hospital admissions (medical / psychiatric, and readmissions), increasing medication adherence, overcoming social determinants of health (SDoH), increasing member engagement with community resources, and member retention.

Functions include drafting and maintaining CM policies and procedures, job aids, training content, and program descriptions.

Duties and Responsibilities

• Collaborate with product, operations, marketing, and care management teams to influence and shape the CM program design and strategy, drive change for key issues
• Prioritize programmatic changes based on issue volume, members impacted, utilization / revenue impact, and other relevant metrics.
• Act as the primary CM point of contact for various AbsoluteCare teams as the CM SME, participating in model of care design, collecting feedback from other departments, and communicating it back to the leadership team in an actionable way
• Aggregate and analyze team and member feedback using internal tools, surveys, and available data to gather insights and propose actionable process improvements or program development
• Work with learning development / training team to drive creation of CM content to ensure the CM team is provided key job training and answers to frequently asked questions
• Draft and maintain CM policies and procedures, job aides, training content, and program descriptions
• Meet deadlines and manage competing priorities.

Minimum Qualifications

RN licensure preferred (e.g., RN, APN, CNS)

Experience with complex government-sponsored populations preferred, e.g., Medicaid, Medicare beneficiaries

Working conditions

This job requires the combination of remote work, professional office settings, and comprehensive care center environments. This role requires 40% travel to market locations.

Physical requirements

Direct reports

None.

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members : people who are entitled to some of the best, most focused care this country has to offer.

We call this "care beyond medicine." We have turned the doctor's office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members' needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don't stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

EEO Employer Verbiage : AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.