Remote-Manager, Case Management SNP (California RN License Required)

Alignment Health is a healthcare organization focused on Medicare Advantage solutions, serving seniors and high-risk populations with care management and plan services.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Remote - Manager, Case Management SNP is responsible for the health care management and coordination of care for members with complex and chronic care needs. Assures compliance with SNP program requirements as outlined in the Model of Care. Monitors activities to support the timeliness of Health Risk Assessment (Initial and Reassessment) completion, Individualized Care Plan (ICP) development and Interdisciplinary Care Team (ICT) delivery for SNP members. Monitors and reports program performance, including vendor performance monitoring if activities are delegated. This position is responsible for the day-to-day operational performance of an integrated health management team while ensuring high-quality care management and adherence to regulatory and compliance standards for the appropriate program lines of business. California RN License Required Fully Remote | California Preferred (Outside Bay Area Preferred) Full-Time | Monday–Friday Make an Impact in Medicare Advantage Care We are looking for an experienced and compassionate healthcare leader to join our team as a Manager, Case Management – Special Needs Plan (SNP). In this fully remote leadership role, you will oversee a high-performing care management team dedicated to improving outcomes for members with complex and chronic healthcare needs. This is an exciting opportunity to lead meaningful work that directly impacts vulnerable populations while helping shape innovative care management strategies in a growing organization. If you are passionate about member advocacy, operational excellence, regulatory compliance, and developing strong clinical teams — we would love to hear from you. What You’ll Do As the Manager, Case Management – SNP, you will oversee day-to-day operations of an integrated care management team supporting Medicare Advantage SNP members. You will ensure compliance with CMS Model of Care requirements while driving quality, efficiency, and member-centered outcomes. Key Responsibilities • Lead, coach, and develop a high-performing case management team serving SNP members • Ensure timely completion of: • Health Risk Assessments (Initial & Reassessments) • Individualized Care Plans (ICPs) • Interdisciplinary Care Team (ICT) activities • Monitor operational and quality performance metrics and implement improvement strategies • Oversee regulatory audits, compliance initiatives, and quality assurance activities • Collaborate cross-functionally with: • Utilization Management • HEDIS/STARS • Quality Improvement • Provider and Clinical Operations teams • Analyze reporting trends and operational data to support strategic decision-making • Promote a culture of accountability, collaboration, and continuous improvement • Support program growth and operational excellence within the Medicare Advantage SNP population What You Bring: Required Qualifications • Active, unrestricted California RN license • Associate’s or Bachelor’s Degree in Nursing • Minimum 5 years of clinical case management experience • Minimum 1 year of experience supporting SNP programs within a health plan environment • Willingness to obtain RN licensure in additional company markets, if needed • Strong understanding of: • CMS SNP Model of Care • Medicare Advantage regulations • Care coordination and population health strategies Preferred Qualifications • BSN or MSN • 2+ years of leadership or supervisory experience in managed care or health plan operations • Case Management certification (CCM, ACM, or equivalent) • Experience with utilization review criteria such as MCG guidelines Skills for Success • Strong leadership and team development capabilities • Excellent communication and relationship-building skills • Data-driven mindset with the ability to analyze trends and drive performance • Experience working with EHR systems and healthcare technology platforms • Strong organizational, project management, and problem-solving abilities • Ability to thrive in a fast-paced, collaborative, remote environment Why Join Us? • Fully remote flexibility • Opportunity to lead and grow within a rapidly expanding organization • Meaningful work improving outcomes for high-risk Medicare populations • Collaborative, mission-driven culture focused on quality care and innovation • Ability to influence and enhance case management programs at scale • Competitive compensation and benefits package Physical Requirements Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role. • Regularly required to communicate effectively via phone and video conferencing • Frequent sitting, standing, typing, and computer use • Occasionally lift and/or move up to 10 pounds • Close vision and ability to adjust focus required for computer-based work • Join a team that is committed to delivering exceptional care, improving member outcomes, and driving innovation in Medicare Advantage case management. Pay Range: $113,332.00 - $169,999.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. • DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.