Job Overview
Location
Remote
Job Type
Full-time
Category
Human Resources
Date Posted
June 3, 2026
Full Job Description
📋 Description
- • Serve as a key leader within the SNP Care Management team, responsible for onboarding new employees and providing ongoing education, coaching, and mentorship to clinical staff.
- • Conduct documentation audits and deliver real-time feedback to enhance clinical team expertise and ensure adherence to care standards.
- • Ensure compliance with CMS SNP Model of Care (MOC), NCQA standards, and Medicare Advantage regulatory requirements across all care management activities.
- • Assist in developing, implementing, and evaluating policies and procedures related to care management processes and workflows.
- • Monitor team performance standards, productivity metrics, and staffing coverage to maintain operational efficiency and member service quality.
- • Formulate and execute educational strategies to build clinical competencies and improve team performance across the SNP care management unit.
- • Perform data collection and analysis to identify trends, uncover opportunities for improved care practices, and drive evidence-based interventions.
- • Provide clinical, procedural, and interpretational support to Care Managers and other team members during escalated or complex member cases.
- • Serve as a liaison between SNP Care Management, Peak Health providers, pharmacy, behavioral health partners, and community-based agencies to coordinate member care.
- • Participate in Interdisciplinary Care Teams (ICT) with primary care providers and beneficiaries/caregivers to align care plans and optimize outcomes.
- • Utilize Peak Health’s analytics tools to monitor HRA timeliness, care plan compliance, ICT effectiveness, utilization trends, and quality outcomes.
- • Support quarterly reporting of delegated case management processes to meet accreditation standards and assist in submission of required documents to accrediting bodies.
- • Collaborate with Quality Management and Compliance teams to improve Stars ratings, HEDIS performance, utilization management, and audit readiness.
- • Escalate and review high-risk, high-need member cases to ensure timely interventions, appropriate community resource connections, and care plan adjustments.
- • Present complex clinical data and operational insights to stakeholders ranging from frontline staff to executive leadership.
- • Maintain strong working relationships with internal and external stakeholders to foster collaboration and alignment across care delivery functions.
- • Fill in for Care Managers during high-volume or peak periods to ensure uninterrupted member support and service continuity.
- • Operate in a standard office environment with occasional travel required for offsite meetings and stakeholder engagements.
- • Work a full-time schedule of 40 hours per week in an exempt role supporting SNP care management operations.
🎯 Requirements
- • Current Registered Nurse license issued by the state where services are provided or active multi-state RN license through eNLC
- • Five (5) years of healthcare clinical experience
- • Two (2) years of experience in Care Management, Case Management, or Population Health
🏖️ Benefits
- • Exempt status with full-time 40-hour weekly schedule
- • Remote work arrangement with occasional travel for offsite meetings
- • Opportunity to influence quality outcomes and compliance across a Medicare SNP population
- • Direct impact on clinical team development through mentoring and coaching responsibilities
Skills & Technologies
About West Virginia University Hospitals, Inc.
West Virginia University Hospitals is the clinical enterprise of West Virginia University, operating a network of academic medical centers, community hospitals, and outpatient clinics across West Virginia. It provides tertiary and quaternary care, medical education, and research, anchored by J.W. Ruby Memorial Hospital in Morgantown. Services include cancer, heart, trauma, pediatrics, and behavioral health. The system serves as the state’s largest employer and leads rural health initiatives, telemedicine, and graduate medical training programs. Governance is through West Virginia University Health System, a tax-exempt, nonprofit subsidiary of the university.
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