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

About the role

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.

Responsibilities

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.

• 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

Requirements

• 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
• Fully Remote (California Preferred, Outside Bay Area Preferred)
• Full-Time, Monday–Friday
• Physical requirements:
  • 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

Qualifications

• BSN or MSN
• 2+ years of leadership or supervisory experience in managed care or health plan operations
• Case Management