Director, Enterprise Care and Disease Management

Director, Enterprise Care and Disease Management page is loaded## Director, Enterprise Care and Disease Management locations:
Bend, ORtime type:
Full time posted on:
Posted Yesterday job requisition :

* Join Pacific Source and help our members access quality, affordable care!
*** Pacific Source is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.
** Pacific Source values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Director of Enterprise Care and Disease Management leads the design and execution of an integrated, enterprise-wide care management model across all lines of business—Commercial, Medicare, Medicaid, D-SNP, and specialty programs. Responsibilities include oversight of Transitions of Care (TOC), Rising/Emerging Risk Management, Moderate/High-Risk Case Management, D-SNP Care Coordination, and Disease Management (DM). This role ensures delivery of high-quality, cost-effective care management that improves health outcomes, enhances member experience, reduces avoidable utilization, and meets regulatory and quality standards (CMS Stars, NCQA, OHA QIMs).

Success requires strong clinical expertise, deep knowledge of chronic disease pathways, proven experience implementing DM interventions (e.g., diabetes and hypertension control), proficiency in risk stratification, and the ability to manage vendors and deploy innovative care models.
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* Essential Responsibilities:

*** Oversee risk-tiered programs including Transitions of Care (TOC), rising/emerging risk, moderate/high-risk, D-SNP, and Disease Management across all lines of business.
* Design and implement disease management programs to improve chronic condition outcomes (e.g., HbA1c, BP, COPD, CHF) and achieve Stars, HEDIS, and QIM performance metrics.
* Establish consistent care pathways, assessment tools, workflows, and outcome monitoring for case and disease management programs.
* Integrate predictive analytics and risk stratification to identify high-need members and guide targeted interventions.
* Track outcomes, utilization, readmissions, and cost indicators through dashboards and reporting tools.
* Direct daily operations, maintain regulatory compliance (CMS, NCQA, state), and oversee HRAs, assessments, and individualized care plans
* Align DM, CM, UM, BH, pharmacy, and quality programs to deliver a cohesive population health strategy.
* Lead vendor selection, integration, audits, and performance oversight to ensure SLAs, quality standards, and clinical outcomes are met.
* Champion adoption of tools for predictive analytics, remote monitoring, and member engagement.
* Utilize Lean methodologies, visual boards, and daily huddles to monitor KPIs and drive process enhancements
* Oversee hiring, coaching, performance reviews, and staff development. Promote accountability and clinical excellence.
* Develop budgets, participate in enterprise initiatives, RFP development, and quality strategy.
* Collaborate with providers and internal teams to optimize care coordination. Embed evidence-based practices and motivational interviewing in care management programs.
* Drive integration of physical, behavioral, and oral health programs within the care management model.
* Actively participate in strategic committees, enterprise projects, and RFP development to align care management with organizational goals.
* Work with providers, community organizations, and stakeholders to strengthen care coordination and address social determinants of health.
** Supporting Responsibilities:
*** Partners with providers, community organizations, and internal departments to coordinate care and optimize member engagement.
* Participate in and support project…