Job Details

POSITION SUMMARY

The Medical Case Management Manager (Manager, Enhanced Case Management (ECM)) leads the development, delivery, and continuous improvement of the ECM program, ensuring high quality care coordination and advocacy for member with complex health needs. This role provides direct leadership and mentorship to the ECM team, evaluates and enhances departmental workflows, and fosters strong internal and external partnerships through exceptional communication and relationship building skills. The Manager maintains expertise in self funded benefits administration and government programs such as Medicare and Medicaid to guide members in understanding and optimizing their available coverage options. In addition to managing a limited caseload, the position addresses client inquiries, resolves member escalations, and collaborates with organizational leadership to strengthen program strategy, performance, and impact.

ESSENTIAL FUNCTIONS

• Develops and directly manages Enhanced Case Management Advocates and Supervisors, while providing indirect oversight to the Case Managers through supervisory staff. Monitors department dashboards and conducts case audits to ensure teams consistently meet or exceed quality standards and KPIs.
• Fosters a collaborative, continuous improvement environment and supports staff in resolving challenges and enhancing performance through constructive, supportive feedback.
• Engage with the Client Management and Value Team to offer insight related to high-dollar claimants and provide a clear explanation of ECM strategies, efforts, and impact.
• Identify members from our ASO Self-Funded and Co-Sourcing Partially Self-Funded Clients based on current medical condition(s), future claim costs, and current financial assessment for Enhanced Case Management evaluation and identify strategic solutions.
• Maintain continuous knowledge of Medicare, Medicaid, and other government programs, including application processes, eligibility criteria, dual eligibility, and coordination of benefits (COB).
• Identify trends and opportunities to collaborate with Medical Management leadership to enhance processes and strategies to improve quality, efficiency, and outcomes.
• Manage a case load of high-complexity members to support their needs, evaluate coverages and offer resources.
• Promotes an environment of continuous improvement and collaboration and assists in troubleshooting and resolving escalated challenges quickly by utilizing an empathetic approach.
• Coordinate with Client Management and other internal departments to answer questions and resolve client challenges.
• Assist in selecting and building the right teams to meet long-term talent planning needs and achieve business goals.
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Performs other related duties as assigned.

EDUCATION

• Bachelor's degree or equivalent work experience required.

EXPERIENCE AND SKILLS

• At least 5 years of Case Management experience, preferably from a third-party administrator, carrier, or within the healthcare industry required.
• At least 3 years at a supervisor level and successfully demonstrated leadership competencies required.
• Demonstrated expertise in Medicaid, Medicare, eligibility processes, and coordination of benefits.
• Experience managing teams of employees with a variety of backgrounds and tenure.
• Ability to monitor and prioritize multiple deadlines and projects simultaneously.
• Experience reading, analyzing, and reviewing organizational metrics and data, preferred.
• Comfortable managing competing priorities and guiding others in a fast-paced environment.
• Excellent written and verbal communication skills with the ability to influence cross-functionally and present to clients/leadership
• Proven experience building training programs, conducting audits, and providing structured feedback.

POSITION COMPETENCIES

• Accountability
• Communication
• Action Oriented
• Timely Decision Making
• Building Relationships/Shaping Culture
• Customer Focus

PHYSICAL DEMAND

This is a standard desk role long periods of sitting and working on a computer are required.

WORK ENVIRONMENT

Remote

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.

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