Care Management Manager Remote

📋 Description

• • Lead the strategic and operational oversight of care management across utilization review, acute/emergency department care, and ambulatory community settings for Intermountain Health’s Nevada market. You will orchestrate multidisciplinary teams (social work, complex-care planning, transitions-of-care, and utilization management) to deliver seamless, patient-centered care that meets rigorous state, federal, and payer requirements.
• • Own the full P&L and quality outcomes for your department. Translate enterprise KPIs into day-to-day tactics, balancing clinical excellence with financial stewardship. You will monitor length-of-stay, readmission, denial, and patient-satisfaction metrics; rapidly course-correct when trends drift; and present data-driven insights to C-suite and payer partners.
• • Champion patient experience and advocacy programs. Coach and mentor frontline staff in service-excellence techniques, ensuring every interaction reflects Intermountain’s mission of “helping people live the healthiest lives possible.” Partner with Patient Experience teams to design and deploy initiatives that improve CAHPS scores and reduce grievances.
• • Drive system-wide collaboration with physicians, nursing leaders, revenue-cycle teams, post-acute providers, and community organizations. You will sit on executive councils, lead root-cause analyses, and negotiate care-transition protocols that reduce avoidable admissions and emergency visits.
• • Spearhead high-impact process-improvement projects using Lean/Six Sigma methodologies. Facilitate Kaizen events, value-stream mapping, and rapid-cycle tests of change. Document ROI and publish best-practice toolkits that scale across 34 hospitals and 400+ clinics.
• • Manage workforce development and succession planning for a diverse team of RNs, social workers, care coordinators, and analysts. Create competency ladders, oversee annual evaluations, and deploy just-in-time education that keeps staff current with evolving regulations and technology.
• • Ensure 100 % compliance with CMS Conditions of Participation, Nevada state licensing, Joint Commission standards, and payer medical-necessity criteria. Partner with Compliance, Legal, and Quality to conduct audits, remediate deficiencies, and maintain an audit-ready environment.
• • Serve as the escalation point for complex cases involving ethical dilemmas, payer disputes, or high-cost outliers. Provide real-time clinical and financial decision support to bedside teams, ensuring safe discharges and optimal resource utilization.
• • Travel up to 25 % within the Nevada region to provide on-site leadership, rounding, and education at hospitals, clinics, and skilled-nursing facilities. Build trust and visibility with frontline staff and physician champions.
• • Leverage Intermountain’s AI-enhanced platforms (e.g., HiredScore, internally built predictive models) to forecast demand, stratify risk, and match patients to appropriate care pathways. Promote a culture of innovation where data science and human compassion intersect.
• • Model Intermountain’s values of integrity, empathy, and excellence. Foster an inclusive environment where every caregiver feels heard, respected, and empowered to improve the health of our communities.