Description
Lead and build a high-impact Care Management program in a value-based environment.
We’re hiring a hands-on RN leader to build and lead a network-wide Care Management program within a clinically integrated network operating in value-based, risk-driven models.
This is not a traditional case management role. We are looking for a leader who can develop strategy, build strong teams, and drive measurable improvements in quality, utilization, and patient outcomes—particularly within FQHC and Medi-Cal populations.
In this role, you will partner closely with health centers, health plans, and internal stakeholders to design and implement scalable care management strategies that address health disparities, improve performance, and support success in risk-based contracts.
Who we are looking for:
Experience leading care management or case management teams (RNs/LVNs or interdisciplinary staff)
Background in value-based care or risk-based contract environments
Experience working with FQHC, Medi-Cal, or underserved populations
Demonstrated ability to build or scale care management or population health programs
Comfortable using data (HEDIS, Arcadia, or similar tools) to drive decision-making
Able to operate both strategically and hands-on when needed
Strong collaborator who works effectively across teams and stakeholders
What You’ll Do:
Leadership & Program Development
Lead and develop a team of care managers (RNs/LVNs) and health care liaisons
Build and execute a network-wide Care Management program aligned to risk-based contracts
Develop workflows, tools, and processes to ensure program success and scalability
Serve as a clinical resource and subject matter expert to member health centers
Care Management & Clinical Oversight
Identify at-risk populations and coordinate care to improve outcomes and control costs
Oversee care coordination across health plans and health centers
Ensure delivery of care that is safe, timely, effective, efficient, and patient-centered
Support whole-person care through comprehensive assessments and care plan development
Quality Improvement & Data-Driven Performance
Use payer and Arcadia reports to identify performance gaps and implement action plans
Drive improvement in quality metrics, access, utilization, and patient outcomes
Apply performance improvement methodologies (HEDIS, PDSA, etc.)
Support health equity initiatives and address social determinants of health
Utilization Management
Partner with MSO and health centers to conduct utilization management reviews
Analyze utilization patterns (ED/IP) and implement improvement strategies
Collaborate with payers to design and optimize utilization processes
Coding & Documentation Integrity
Provide clinical guidance related to coding and documentation audits
Use audit findings to drive performance improvement and team education
Requirements
Qualifications Required
Active RN license
Minimum 5 years of clinical experience (6+ years preferred)
Experience leading clinical or care management teams
Strong interpersonal, communication, and collaboration skills
Preferred
Experience in value-based care, population health, or utilization management
Knowledge of Medi-Cal, HEDIS, P4P, and quality improvement methodologies
Experience with Arcadia or similar care management/data platforms
CCMC or equivalent certification
Core Competencies
Clinical leadership and team development
Program building and operational execution
Data-driven decision-making and performance management
Strong accountability and follow-through
Cross-functional collaboration and stakeholder engagement
Critical thinking and problem-solving
Work Environment & Requirements:
Remote/Hybrid work environment
Up to 25% travel required
Flexible schedule (including 9/80 option)
Additional Requirements:
Must possess a valid driver’s license, active insurance, and reliable transportation for work-related travel
Must be able to work occasional evenings and weekends as needed within a 40-hour workweek
