Manager, Case Management

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

The Manager, Case Management is responsible for providing dedicated clinical leadership and operational oversight for PCRX clinical services. This role ensures standardized workflows, consistent clinical quality, effective staff management, and scalable operations. The Manager serves as the primary point of accountability for PCRX clinical performance, supporting sustainable growth while reducing operational risk.

Primary Responsibilities

• Oversee, coach, and manage performance of PCRX clinical staff
• Serve as the primary clinical escalation point for operational and workflow issues
• Foster a culture of accountability, quality, and continuous improvement
• Develop and maintain standardized workflows, policies, and procedures for PCRX clinical activities
• Identify inefficiencies and gaps; implement corrective actions and process improvements
• Own onboarding, training, and competency validation for PCRX clinical staff
• Ensure staff are trained on workflows, tools, documentation standards, and internal guidelines
• Monitor clinical quality, documentation consistency, and adherence to internal standards
• Support audit readiness and quality review activities
• Provide data-informed recommendations to leadership on staffing, workflow, and capacity needs

Qualifications

• Clinical background in care management, utilization management, pharmacy-related clinical programs, or similar healthcare operations
• 2+ years of clinical leadership or people-management experience
• Strong understanding of clinical workflows, training models, and quality management
• Demonstrated ability to standardize processes and lead operational change
• Excellent communication, organizational, and problem-solving skills
• Experience managing pharmacy-adjacent or medication-focused clinical programs preferred
• Experience scaling clinical operations or maturing start-up operational models preferred
• Familiarity with utilization guidelines, clinical decision support tools, or structured review frameworks preferred

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.