Remote Rn Auditor Jobs in Michigan (NOW HIRING)

Role Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned market to ensure the delivery of high-quality, compliant, and member-centered clinical and non-clinical services.

Work Arrangement:

• Remote - Fully remote associate must be located in Michigan (MI).
• Some travel to state and other meetings will be required

Responsibilities:

• Partner with the Market Chief Medical Officer (CMO) and other market leaders to develop, execute, and monitor the plan's population health strategy while supporting equitable, whole-person care for members.
• Collaborate with CMO, Quality Director, and other market leaders and evaluate continuous quality improvement and process optimization efforts across care coordination programs and initiatives
• Oversee market-specific clinical programs, including Case Management (CM), Bright Start Maternity program, and Community Outreach
• Ensure alignment of care coordination programs with population health strategy, enterprise policies, and contractual requirements
• Direct and oversee Care Coordination - Integrated Care Team (ICT) clinical and non-clinical staff; support staffing, hiring, and professional development
• Ensure compliance with state, federal, and contract requirements, including the Michigan Department of Health & Human Services (MDHHS) contract
• Implement processes for identifying, assessing, and developing care plans for members with special healthcare needs
• Ensure coordination of care across physical health, behavioral health, and community-based services
• Serve as the primary point of contact with state regulatory agencies on care coordination-related activities
• Develop and implement engagement strategies for members
• Ensure effective coordination of services across multiple healthcare entities and providers
• Drive integration of care coordination and disease management within population health and quality improvement initiatives
• Lead performance measurement efforts to assess and improve health outcomes and operational effectiveness
• Monitor transition of care programs and care coordination quality performance metrics; implement corrective actions as needed
• Serve as liaison between market and enterprise leadership; share best practices and align strategies
• Partner with regulatory, external quality review organizations such as (but not limited to) the National Committee for Quality Assurance (NCQA), and Quality Assessment and Performance Improvement (QAPI) teams
• Prepare and deliver reporting, including key performance indicators (KPIs), program performance, and utilization trends
• Support procurement activities (RFPs/RFIs) and provide subject-matter expertise for care coordination and population health expansion efforts
• Perform other duties as assigned

Education & Experience:

• Bachelor's degree in Nursing or other health related field with an active, unrestricted Registered Nurse (RN) licensure in MI required plus a Masters Degree or other advanced degree in nursing, social work, health services research, health policy, information technology, or other relevant field
• 3 to 5 years of progressive management experience, including staff management, within a Medicaid managed care environment
• 3 years of experience leading case management programs, including program design, implementation, and strategic execution
• 3 years of experience with NCQA standards and regulatory guidelines
• Certified Case Manager (CCM) certification required
• Experience developing, driving, and measuring clinical operations, population health strategy, and performance improvement initiatives preferred

Licensure:

• Active, unrestricted RN licensure in MI required.

Skills & Abilities:

• Strong leadership and team management skills with the ability to lead multidisciplinary clinical and non-clinical teams
• Deep understanding of population health, care coordination, and managed care operations
• Knowledge of Medicaid regulations, state contract requirements, and compliance standards
• Proven ability to design, implement, and optimize clinical programs and operational workflows
• Strong analytical and performance management capabilities with a focus on outcomes and quality improvement
• Excellent communication and collaboration skills, with the ability to engage executive leadership and external stakeholders
• Ability to manage multiple priorities and drive execution in a complex, highly regulated environment
• Strategic thinker with the ability to translate population health goals into actionable operational plans

• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)