Manager, Care Management (RN) - Maternal Child Health

Manage a care management team supporting Maternal Child Health members. Oversee care management workflows, escalations, and complex cases to drive high-quality, cost-effective outcomes. Review required documentation for compliance with federal, state, NCQA, and contractual requirements. Contribute to policies and procedures, and to the development and oversight of care management programs.

Direct daily activities of care management staff, including reviewing and approving caseloads based on state requirements, staff experience, and member needs. Manage escalation processes and complex cases, providing guidance to team members. Coordinate resolution of member escalations and complaints and assist with audits and evaluations of care programs.

May perform telephonic, digital, or home/site outreach to assess member needs. Set goals and reporting metrics for the team, partnering with senior leadership. Monitor audits to ensure regulatory compliance. Provide coaching and feedback to improve member and provider experience. Support onboarding, hiring, and training of new team members.

This is a remote role with occasional in-office engagement and required state meetings; must reside in Delaware. Requires graduation from an accredited nursing school or a bachelor's degree plus 5+ years related experience. Active RN license (state or compact) required. Salary: $102,900–$190,500.