Director, Care Management

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Lead the care management team and oversee the care management of members to formulate and evaluate high-quality, cost-effective healthcare outcomes.

• Create strategies and objectives within care management to enhance member and/or provider experiences.

• Manage and assess departmental operations, including the care management model, staffing, technology utilization, and staff competencies.

• Supervise the performance of the care management team, focusing on improvement and talent management.

• Establish team goals and objectives while monitoring care management data and reporting metrics.

• Ensure the development and execution of care management policies and procedures complies with federal, state, and NCQA standards.

• Keep abreast of trends and best practices in payer care management and related domains.

• Drive process enhancements to achieve quality and cost-effective healthcare outcomes.

• Aid in the development and refinement of clinical care pathways.

• Formulate care management strategies and offer recommendations that align with organizational goals.

• Collaborate with other departments and senior leadership to create the department budget.

• Design onboarding, hiring, and training strategies for new members of the care management team.

• Execute additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s degree.

• Over 7 years of relevant experience (84+ months).

• Previous management experience.

• Equivalent experience may be considered in lieu of the specified bachelor’s degree based on applicable knowledge, duties, scope, and skills.

• A current state Registered Nurse (RN) license is preferred.

• Familiarity with payer care management and related areas.

• Capability to develop care management strategies, policies, procedures, budgets, and training programs.

• Proficiency in overseeing performance, quality, cost-effectiveness, reporting metrics, and regulatory compliance.

• Adherence to all policies and standards.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

• Flexible work arrangements with options for remote, hybrid, field, or office work schedules.

• Potential incentives included in total compensation.