Remote Manager, Case Management (RN)

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity
As the Manager of Case Management at Vālenz, you’ll provide oversight and operational leadership for Case, Disease, and Maternity programs. You will ensure these services are delivered effectively and efficiently, aligning with the company’s high standards for quality and cost-effectiveness. In this role you’ll not only manage the day-to-day operations but also drive continuous improvements and innovations in care management practices. This position offers the opportunity to significantly impact patient care and outcomes, making it an essential part of Vālenz’s mission to deliver superior healthcare services.

Things You’ll Do Here:

• Clinical Program Oversight:
  • Oversee, evaluate, and maintain clinical program productivity, KPIs, and performance standards.
  • Generate and analyze outcome reports to guide staff in improving clinical and financial outcomes for clients.
• Quality Control and Compliance:
  • Implement enhanced quality review processes for timely supervisory case reviews.
  • Ensure adherence to confidentiality, HIPAA standards, and URAC compliance.
  • Maintain compliance with federal, state, and local regulations, including CMSA’s Standards of Practice.
• Team Leadership and Development:
  • Conduct annual performance evaluations, create improvement plans, and manage staff terminations.
  • Lead hiring, training, and development of new care staff.
  • Collaborate with Vice President of Care Management on performance-related issues.
• Strategic Initiatives and Accreditation:
  • Spearhead accreditation efforts, focusing on successful URAC accreditation and reaccreditation.
  • Assist in new product development and ensure current products are delivered effectively.
  • Develop and maintain knowledge of cultural differences and socioeconomic factors affecting care.
• Operational Excellence and Collaboration:
  • Collaborate with other departments for integrated administrative activities and clinical operations.
  • Develop professional, scalable reporting for Care clients in partnership with Customer Support Executive team.
  • Promote coordination and communication within the company regarding quality improvement and clinical operations.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team:

• Experience
  • 5+ years of experience managing case management and disease management programs and the associated staff.
  • 7+ years of experience in diverse case management, capable of effectively handling cases across all age groups and a wide range of medical conditions.
  • Experience in a managed health care program setting, with a deep understanding of care coordination and patient-centered care.
  • Proficient knowledge of NCQA, URAC, or similar accreditation standards and participation in accreditation surveys.
  • Experience effectively engaging with healthcare professionals, clients, and stakeholders at all levels.
  • Demonstrated ability to implement strategic plans, adhere to budgets, and provide insights for efficient operation and growth.

• Credentials
  • BSN or related degree.
  • An active, unrestricted RN license in the state of residence, including a compact license.
  • Current Certified Case Manager (CCM) or ability to obtain.

Highly preferred requirements include:

• MSN, MBA, or related degree in healthcare administration.
• Knowledge of self-funded plans, MGU, or stop-loss.

Where You’ll Work
This is a remote role.
Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you’re ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.