Care Management Operations Specialist

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Manages day-to-day operations of Care Management functions, ensuring compliance with internal procedures and external regulatory requirements.
• Oversees operational performance metrics and implements process improvements to optimize care delivery and administrative efficiency.
• Leads and coordinates departmental projects from planning through implementation, defining scope, timelines, and deliverables.
• Manages and provides oversight to Care Management Operations, including project coordination and operational activities that support departmental goals.
• Tracks and monitors project milestones and department workflows to ensure timely completion of goals.
• Manages meetings, workgroups, and training sessions in support of departmental initiatives.
• Identifies, designs, and implements process improvements and performance initiatives across Care Management Operations.
• Serves as liaison between Care Management leadership, analytics, IT, and other departments to ensure cross-functional collaboration.
• Develops dashboards, progress reports, and analytical tools to monitor performance and outcomes.
• Supports development and rollout of new programs, technologies, and systems to enhance Care Management operations.
• Provides regular reports and presentations to leadership on progress, outcomes, and key initiatives.
• Ensures operational and project deliverables are achieved on time, within scope, and aligned with regulatory and quality standards.
• Delivers measurable improvements to performance metrics, efficiency, and member and provider satisfaction.
• Resolves multifaceted issues that require consideration of clinical, operational, and strategic factors, drawing upon advanced knowledge of healthcare operations and project management best practices.
• Oversees and manages complex operational and project management functions that require knowledge of care management workflows, data analysis, and continuous improvement methodologies.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• License and current registration to practice as a Registered Professional Nurse in the state of New York required for RNs preferred or
• Current registration to practice as a Licensed Master Social Worker (LMSW) in New York State preferred

Education:

• Bachelor's Degree in Business, Nursing, Healthcare or other related industry, or the equivalent combination of work and experience required or
• Master's Degree in Social Working required

Work Experience:

• Minimum five years progressive management experience preferably in a customer service or health care environment required
• Proficient in Personal Computers applications, including Microsoft Word and Excel required
• Knowledge of medical terminology, pharmacology information and /or insurance terminology required
• Strong knowledge of operations of manual and automated office systems and procedures required
• Strong knowledge of third-party payer requirement for reimbursement preferred
• Strong operational skills with attention to detail required