RN Manager, Medicare and DSNP Utilization Management

REMOTE position: Mon- Fri 8am-5:00pm no weekends no holidays. Essential Functions-Supervise and support a team of care coordinators and case managers ensuring they adhere to clinical standards and protocols. -Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination. -Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies. -Facilitate collaboration between clinical teams physicians and other healthcare providers to optimize patient care. -Review and analyze patient data to identify trends areas for improvement and opportunities for intervention. -Conduct regular performance evaluations and provide ongoing training and development for staff members. -Manage case load assignments and prioritize patient cases based on acuity and resource availability. -Oversee the implementation of new care models or technologies to improve patient care and operational efficiency. -Ensure accurate documentation and reporting of case management activities and patient care RequirementsJob DetailsJob ProfileJob ProfileJP202967 - Manager ClinicalJob Families for Job ProfilesJob Families for Job Profiles119 - Care Coordination / Case ManagementWorker Sub-TypeWorker Sub-TypeRegularWorker TypeWorker TypeEmployeeTime TypeTime TypeFull timeEmployee Contract TypeEmployee Contract Type(empty)Compensation GradeCompensation Grade8Remote TypeRemote TypeRemotePrimary LocationPrimary Location399 Revolution Drive Somerville (Assembly Row Main Building)Primary Job Posting LocationPrimary Job Posting LocationSomerville-MAAdditional LocationsAdditional Locations(empty)Additional Job Posting LocationsAdditional Job Posting Locations(empty)Scheduled Weekly HoursScheduled Weekly Hours40Work ShiftWork ShiftDay (United States of America)Recruiting Start DateRecruiting Start Date03/30/2026Target Hire DateTarget Hire Date04/06/2026Target End DateTarget End Date(empty)Additional InformationUnion Membership from Job ProfileUnion Membership from Job Profile(empty)Allowed Unions from Job ProfileAllowed Unions from Job Profile(empty)Collective Agreement DetailsCollective AgreementCollective Agreement(empty)Job DescriptionJob DescriptionEducationBachelors Degree requiredMasters Degree Related Field of StudyLicenses and CredentialsMassachusetts Registered Nurse RN license requiredExperienceAt least 3-5 years of experience in clinical care coordination or case management requiredLTSS (Long-Term Services and Supports) experience preferredAt least 2-3 years of experience in a supervisory or leadership role requiredAt least 2-3 years of Medicare and DSNP UM experience requiredKnowledge Skills and AbilitiesStrong leadership and team management skills to effectively guide and support clinical communication and interpersonal skills to collaborate with healthcare providers and skills to assess patient care data and identify areas for -solving abilities to address complex care coordination issues and implement effective of regulatory requirements and industry best practices in clinical care and case in healthcare management software and electronic health record systems.