Manager I Care Management

Manager I Care Management

Location: San Juan, Puerto Rico.

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. This position will be based on: 1001 San Roberto St, Ste 101, 401 & 501, San Juan, PR.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work 8-hour shifts Monday through Friday and must be available to work within the operational hours of 8:00 a.m. to 6:00 p.m. (AST). Additional hours, including weekends or holidays, may be required based on operational needs.

The Manager I Care Management is responsible for managing a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.

How you will make an impact:

Primary duties may include, but are not limited to:

• Assesses the medical necessity of outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Oversees process improvement, quality assurance, and adherence to applicable medical policy, care management best practices, relevant clinical standards, and member contract.
• Ensures prevention and health management program accreditation standards are achieved.
• Participates in establishing strategic plans and objectives; aligning, developing, and implementing functional area policies and procedures to support strategic plans and objectives.
• Participates in establishing and managing the annual budget productivity targets.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires BS in Nursing and minimum of 5 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in applicable state(s) required.

Preferred Skills, Capabilities, and Experiences:

• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level.
• Certification as a Case Manager preferred.
• Additional schooling or certifications preferred.

Job Level: Manager

Workshift: Job Family: MED > Licensed Nurse