About Lucent Health
Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.
Company Culture
We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.
Honest
- Transparent Communication: be open and clear in all interactions without withholding crucial information
- Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
- Truthfulness: provide honest feedback and report any issues or challenges as they arise
- Trustworthiness: build andmaintaintrust by consistentlydemonstratingreliable behavior
Ethical
- Fair Decision Making: ensure all actions and decisions respect company policies and values
- Accountability: own up to mistakes and take responsibility for rectifying them
- Respect: treat colleagues, clients and partners with fairness and dignity
- Confidentiality: safeguard sensitive information and avoid conflicts of interest
Hardworking
- Consistency: meet or exceed deadlines,maintaininghighproductivitylevels
- Proactiveness: take initiative to tackle challenges without waiting to be asked
- Willingness: voluntarily offer toassistinadditionalprojects or tasks when needed
- Adaptability: work efficiently under pressure or in changing environments
Summary
The Manager of Large Case Management is responsible for the overall leadership, strategy, and performance of the Large Case Management (LCM) function. This role oversees clinical operations for high-cost and complex medical cases, ensuring quality member outcomes, regulatory compliance, and financial stewardship. The Manager leads Supervisors and case management staff, drives operational excellence, and partners cross-functionally to optimize care delivery and cost containment strategies. This role is accountable for program development, vendor strategy, reporting, and continuous improvement initiatives that enhance clinical and financial outcomes. The Manager reports to the Director of Case Management and may require intermittent travel.
Responsibilities
- Provide strategic and operational leadership for the Large Case Management program, ensuring alignment with organizational goals and clinical best practices.
- Oversee daily operations through direct leadership of Supervisors, ensuring productivity, quality, timeliness, and documentation standards are met.
- Establish and monitor key performance indicators (KPIs),identifying trends and implementing action plans to improve outcomes and efficiency.
- Lead the development and execution of case management strategies for high-cost and complex cases to optimize clinical outcomes and financial impact.
- Support Case Management vendor strategy, performance monitoring, and evaluation ofreferral appropriateness and outcomes.
- Ensure compliance with all accreditation, regulatory, and contractual requirements (e.g., state, federal, URAC, NCQA, HIPAA).
- Partner with Finance and leadership to ensure accuracy, integrity, and insights within stop loss reporting and high-cost claim analysis.
- Lead internal and external audits, quality assurance initiatives, and regulatory readiness efforts.
- Collaborate cross-functionally with Utilization Management, Claims, Network, and Client Services to drive coordinated care and program effectiveness.
- Identify and implement process improvements to enhance quality, efficiency, and scalability of the case management program.
- Develop, implement, and maintain policies, procedures, and clinical guidelines for case management operations.
- Provide leadership, mentorship, and development for Supervisors and team members, including performance management and career progression planning.
- Oversee hiring, onboarding, training, and workforce planning to ensure appropriate staffing and capability development.
- Communicate program performance, outcomes, and strategic insights to senior leadership.
- Lead and support change management initiatives within scope of responsibility.
- Performs other duties as assigned
Qualifications
- Registered Nurse with a minimum of 3-5 years of clinical nursing experience.
- Minimum of 3 years in a healthcare leadership role (e.g.team lead or higher)
- Bachelor’s Degree from an accredited college or university required
- Demonstrated ability to manage and lead a team of direct reports
- Excellent written and oral communication skills
- Strong analytical skills with attention to detail
- Ability to identify areas of improvement and develop action plan to address findings
- Positive, proactive team-oriented approach/attitude
- Strong knowledge of Microsoft Office products
- Holds a current, active, and unrestricted RN license that allows him/her to practice in a state or territory of the United States.
- Relevant certifications such as Certified Case Manager (CCM) may be preferred.
Equal Employment Opportunity Policy Statement
Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.
