Join arenaflex, a leading healthcare organization dedicated to delivering innovative solutions for a rapidly changing world. At arenaflex, we believe that healthcare should be accessible, affordable, and of the highest quality. Our mission is to carry our heart to every moment of your wellbeing, and we're looking for talented individuals to join our team. As a Senior Manager Care Management, you'll play a critical role in driving our clinical team to deliver exceptional care to our members. About arenaflex arenaflex is a leading healthcare organization that's passionate about making a difference in the lives of our members. We're committed to delivering innovative solutions that improve healthcare outcomes, reduce costs, and enhance the overall wellbeing of our community. Our team is dedicated to working together to achieve our mission, and we're looking for like-minded individuals to join us on this journey. Job Summary We're seeking an experienced Senior Manager Care Management to join our team in Texas. As a Senior Manager, you'll be responsible for overseeing the clinical team that supports convenient wellbeing risk screenings, thorough evaluations, care plan development, and member interventions. You'll work closely with administrative and certifying organizations, as well as other healthcare specialty units, to ensure seamless care coordination. Key Responsibilities * Drive the clinical team to deliver exceptional care to our members, including convenient wellbeing risk screenings, thorough evaluations, care plan development, and member interventions. * Serve as a contact with administrative and certifying organizations, as well as other healthcare specialty units, to ensure seamless care coordination. * Provide specialized, professional, and business expertise to support the development and implementation of care management strategies. * Uphold quality improvement projects through effective execution and collaboration with internal and external stakeholders. * Create, execute, and assess plans and strategies to address business issues, including those that cross multiple business capabilities. * Organize program execution and clinical results to drive improved outcomes. * Stay up-to-date on relevant laws, regulations, and industry standards that impact clinical administration. * Communicate effectively with internal and external constituents in both written and oral formats. * Assess and interpret data to inform staff performance, administrative compliance, and the development of new projects and processes to meet business needs. * Collaborate with others to identify and implement action plans that support the development of high-performing teams. * Participate in the recruitment and hiring process for staff, including clearly defined requirements regarding education, experience, technical, and performance abilities. * Create, initiate, monitor, and communicate performance expectations. * Uphold the administration of complex physical and behavioral health cases by being clinically and socially competent with proper training and experience. * Lead regularly scheduled individual and group meetings to focus on member service delivery, completion of administrative tasks, and meeting established performance standards. * Serve as the Care Management informed authority with Aetna Better Health of Texas Medicaid and contract expectations. * Ensure Care Management compliance with contract requirements. * Identify opportunities to implement best practice approaches and introduce innovations to improve results. * Communicate effectively with internal and external constituents in both written and oral formats. * Responsible for gathering clinical functional and quality targets of the agreement. * Demonstrate the ability to act as a model change agent and lead change efforts. * Responsible for maintaining compliance with policies and procedures and implementing them at the staff level. * Ensure care management/care coordination and disease management are part of population health and quality improvement initiatives. * Assess and interpret data, identify areas for improvement, and focus on interventions to improve results. * Responsible for internal and external metrics, including member engagement objectives and state requirements per contract. * Support state reviews, NCQA execution and reviews, and Clinical Methodology for RFPs. Required Capabilities * Active, unrestricted Texas State License in the appropriate functional area (e.g., RN, LPC, LCSW). * 7 years of clinical specialized experience. * 7 years of administrative/administrative experience. * Care management insight. * Knowledge of laws, regulations, and policies that impact clinical administration. * Care management experience. * 3+ years of experience with PC, keyboard navigation, and MS Office Suite applications. Preferred Capabilities * Supervised care experience. * Certified Case Manager (CCM). * Texas Medicaid experience – specifically TX STAR and CHIP. * Graduate degree in social work or a related field. Education * Bachelor's degree required for RN license or graduate degree in social work or a related field. Pay Range The typical pay range for this job is: This pay range addresses the base hourly rate or base yearly full-time compensation for all situations in the job grade within which this position falls. The actual base compensation offer will depend on various factors, including experience, education, location, and other significant elements. This position is eligible for an arenaflex reward, commission, or temporary incentive program. How to Apply If this role sounds like a perfect fit, don't hesitate. Apply today and let's build the future together. Apply To This Job Apply for this job