RN Program Manager, Care Management

Lets do great things together!

About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Position Summary
This is a FT hybrid position based in Portland Oregon.The Manager of Care Management provides operational and clinical leadership for care management programs including care coordination complex case management and population health initiatives. This role ensures the delivery of high-quality member-centered care while optimizing clinical outcomes access and total cost of care. The Manager serves as a clinical and operational leader partnering across the organization and with external stakeholders to design implement and continuously improve care management strategies aligned with regulatory requirements quality metrics and value-based care goals.

Pay Range
$94799.21 - $120867.41 annually (depending on experience)
Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page linked below to be considered for this position.

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Required Skills Experience & Education:

1. Bachelors degree in Nursing (BSN) or related clinical field required; Masters degree preferred.
   
2. Minimum of 5 years of clinical or healthcare delivery experience.
   
3. At least 3 years of experience in care management case management utilization management or population healthpreferably within a health plan.
   
4. Minimum of 23 years of leadership or supervisory experience.
   
5. Active unrestricted clinical license (RN or other relevant healthcare professional) in the State of Oregon required.
   
6. Strong clinical knowledge and application of evidence-based guidelines.
   
7. Demonstrated leadership and team development skills.
   
8. Experience driving operational and clinical transformation initiatives.
   
9. Proficiency in interpreting and leveraging healthcare data and financial metrics.
   
10. Strong project management and organizational skills.
    

Primary Functions:

1. Collaborate in the development implementation evaluation and continuous improvement of clinical programs to support Modas mission strategic goals regulatory requirements and accreditation standards
2. Lead day-to-day operations of care management programs including care coordination case management and disease management.
3. Provide coaching mentorship and performance management to a multidisciplinary team.
4. Foster a culture of accountability continuous improvement and member-centered care.
5. Ensure appropriate staffing models workflow design and resource allocation to meet program demands.
6. Serve as a clinical subject matter expert to guide evidence-based care management practices.
7. Ensure adherence to clinical guidelines regulatory standards and accreditation requirements (e.g. CMS NCQA).
8. Monitor and improve program performance related to quality outcomes member experience and utilization.
9. Develop and execute care management strategies aligned with organizational goals including:
   • Value-based care
   • Population health management
   • Health equity initiatives
10. Identify trends in utilization gaps in care and opportunities to improve access and outcomes.
11. Lead quality improvement initiatives and implement action plans to address performance gaps.
12. Partner with analytics teams to identify data needs and interpret clinical financial and operational performance data.
13. Use data insights to inform program design decision-making and resource prioritization.
14. Oversee reporting of care management outcomes including dashboards and ad hoc analyses.
15. Ensure compliance with all applicable state federal and contractual requirements.
16. Oversee accurate and timely documentation and reporting including submissions to NCQA and other regulatory bodies.
17. Develop implement and maintain departmental policies procedures and standard work.
18. Performs other duties as assigned

Working Conditions:

• Office environment.
• Extensive keyboard telephone work and meetings.
• Extensive sitting.
• Hybrid clinical operational and strategic role requiring both analytical and interpersonal expertise.
• Frequent collaboration with internal departments and external providers partners and vendors.

Together we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.