Managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review
Ensuring compliance with global program elements as well as contractual or regulatory requirements
Developing and implementing workflows and protocols in compliance with global programs and regulatory guidelines
Assisting in identifying opportunities to improve operational efficiencies, clinical quality, and solution performance
Analyzing solution specific reports identifying trends over time
Coordinating service delivery to include member assessment of physical and psychological factors
Partnering with providers to establish short and long-term goals that meet the members’ needs, functional abilities, and referral sources requirements
Identifying members with potential for high-risk complications
Reviewing benefit systems and cost benefit analysis
Evaluating medical, mental health and substance abuse service for cost containment
Supporting program compliance and assisting in identifying opportunities to improve the customer service and quality outcomes
Supporting quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting
Hiring, training, coaching, counseling, and evaluating performance of direct reports

Requires BA/BS and minimum of 5 years of experience in Health Care Management
Current active unrestricted RN and any other state or federal requirements that may apply is required
MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred
Prior bedside obstetric, pediatrics, and/or women's health experience is preferred
Prior experience in Care Management
Prior experience in managing or leading a team or project management is necessary to ensure exceptional attention to detail and an understanding of clinical operations is preferred
Excellent written, oral, presentation, and interpersonal communication skills are strongly preferred
Proficiency in Microsoft Office products—Excel, Teams, Outlook, PowerPoint, Word—and AI tools is strongly preferred
Licensure in CA, NV, and/or WA is preferred

Manager I – Maternal, Child, and Women’s Health Care Management

Key skills