Clinical Program Manager, Care Navigation, US Remote at Carewell

Description

About Carewell

Carewell is a category-defining business dedicated to providing trusted caregiving solutions and support for individuals and families. Through Carewell Family Services, we extend our commitment beyond products to person-centered navigation, care coordination, and advocacy services that address both medical and social needs. Our approach emphasizes compliance, scalability, and high-quality patient experiences while working in close partnership with clinicians and community resources to support better outcomes.

About the Role

This is a rare opportunity to be the first clinical hire and program leader for a growing care navigation program. You'll design, build, and operationalize the infrastructure, workflows, and clinical standards that define how we deliver care at scale — while carrying a limited direct patient caseload during the initial launch phase to inform program design. As you build the program, you'll simultaneously build and lead a multidisciplinary team of advocates, CHWs, LVNs, and other clinical staff.

If you're energized by building systems, leading teams, and driving measurable outcomes in a high-growth environment, this role was written for you.

What You'll Do

Program Leadership & Operations

• Design and implement care navigation workflows, SOPs, clinical standards, and program parameters from the ground up
• Lead the hiring for advocates, CHWs, LVNs, and clinical staff by defining role requirements, conducting interviews, and making hiring decisions in coordination with leadership and HR.
• Lead, mentor, and manage performance of a multidisciplinary clinical team
• Conduct performance reviews, coaching, and corrective action as needed
• Define and implement quality improvement processes to drive continuous program enhancement
• Evaluate, select, and implement care management technology, EHR platforms, and digital tools
• Manage vendor relationships and oversee system integration and optimization
• Develop and execute within a clinical program budget
• Serve as a culture carrier and clinical role model as the team scales

Clinical Oversight & Quality

• Establish and monitor documentation standards, clinical behavioral standards, and performance expectations
• Ensure regulatory compliance with Medicare billing requirements, HIPAA, state telehealth laws, and other applicable regulations
• Develop clinical risk management protocols and escalation pathways
• Oversee appropriate documentation across all systems to support compliance and billing accuracy
• Ensure time-based documentation standards are met (start time, stop time, duration tracking for monthly minute aggregation)

Measurement, Reporting & Accountability

• Develop reporting frameworks for clinical outcomes, quality metrics, and compliance indicators
• Deliver clinical outcomes reporting to internal stakeholders, providers, and payers
• Track and report on program KPIs (see below)
• Use data insights to inform strategic decisions and drive program iteration

Direct Patient Care (Initial Launch Phase)

• Deliver hands-on care navigation services to a limited caseload during program launch to inform workflow design
• Conduct SDOH screenings and connect patients to community resources
• Build trusted relationships with patients, families, and care teams
• Model best practices for documentation and clinical excellence

KPIs You're Responsible For

Clinical Performance

• Clinical team productivity (encounters per clinician, time utilization)
• Clinical outcomes (disease management metrics, care plan adherence, hospitalization/readmission rates)
• Care gap closure rate
• Escalation pattern analysis (volume trends, root cause, training signal identification)
• Patient NPS and satisfaction scores
• Patient Engagement

Program Quality & Compliance

• Documentation compliance rates
• Clinical behavioral and performance standards adherence
• Clinical protocol adoption, consistency across pods, and iteration cadence
• Safety event tracking and response times
• Regulatory audit readiness

Operational Efficiency

• Average time-to-resolution for patient needs
• Caseload capacity and coverage relative to patient volume
• Resource utilization rates
• Cost per patient served
• Revenue cycle metrics (as applicable)

Team & Growth

• Supervisor performance and development
• Team scaling velocity and time-to-productivity for new hires
• Staff retention and engagement

Reporting & Outcomes

• Timely delivery of internal, provider, and payer-facing clinical reports
• Quality of reporting frameworks and data integrity

Who You Are

Must-Have Requirements

• Licensed for multi-state practice — Active Nurse Licensure Compact (NLC) multistate license; prepared to obtain licensure in non-NLC states as program expands
• Clinical credentials — LVN preferred; RN considered for candidates with demonstrated leadership experience and genuine appetite for building and managing programs
• Medicare billing expertise — Direct experience working in a program that required minute-by-minute, time-based documentation for Medicare billing (CCM, TCM, PCM, CHI, RPM, or similar programs)
• Care navigation or case management experience — 3–5+ years in care navigation, case management, care coordination, or closely related patient-facing roles
• Telehealth expertise — Demonstrated ability to deliver remote care management, build rapport, and coordinate care via telephonic and digital tools
• Management experience — Proven track record leading, mentoring, or supervising clinical or operational teams
• SDOH fluency — Comfortable navigating social determinants and connecting patients to resources across complex systems
• Regulatory knowledge — Working understanding of Medicare regulations, HIPAA, and state telehealth compliance requirements
• Quality improvement experience — Track record implementing quality improvement processes to enhance clinical outcomes and operational performance
• Technology implementation — Experience evaluating, selecting, and implementing care management platforms, EHRs, or related clinical systems
• Builder mentality — You see the gap, you fill it, and you document how you did it so others can follow
• Nimble and adaptive — You thrive in ambiguity and treat a fast-changing environment as an opportunity, not a stressor
• Tech-forward — Comfortable with care management platforms, EHRs, and digital tools; quick to learn new systems
• Resilient problem-solver — You don't wait for perfect conditions; you find a way
• Low ego, high output — Equally comfortable owning the detail work and showing up credibly in strategic conversations

Nice-to-Have's

• Experience in a startup, pilot program, or ground-up initiative
• Familiarity with value-based care or population health models
• Bilingual (Spanish or other languages depending on target population)
• CHW (Community Health Worker) certification
• Experience with Motivational Interviewing or trauma-informed care frameworks
• Background in vendor management or platform procurement

Why This Role

• Ground-floor opportunity to shape a program from day one
• Close partnership with leadership — your voice will matter
• Competitive compensation with growth trajectory tied to program expansion
• Meaningful, mission-driven work with visible patient impact

What We Offer 

• Competitive compensation
• Health, Dental, and Vision insurance
• Short-term Disability and Life Insurance (100% employer-sponsored)
• Long-term Disability
• Supplemental Life Insurance (employee-sponsored)
• 401(k) Retirement Plan
• 100% Remote
• Generous paid time off and 6 paid holidays