Sr. Director Care Management and Health Plan

Great Opportunity Sr Director of Care Management/Health Plan Multi Facility Health System

Senior Director partners closely with Quality, Population Health, Utilization Management, Pharmacy, Provider

• Relations, Operations, Product Relations, Compliance and Medical Economics to execute organizational priorities,
• regulatory requirements, and value-based care strategies. This role is accountable for driving measurable improvements in clinical quality, member experience, utilization management and cost containment.
• This position has direct responsibility for ensuring that CM functions are performed in accordance with all contractual and regulatory requirements including compliance with CMS, NCQA, state and accreditation standards unique toeach line of business.
• This position will also prepare and assist with all regulatory reviews including but not limited to federal, state (Health Care Policy and Financing) and Colorado Division of Insurance.
• The Director oversees and leads multiple teams performing and collaborating with stakeholders to accomplish this work.
• The Director reports to the Chief Medical Officer and collaborates closely with them to develop
• and update the Care Management vision and strategy.
• This position is responsible for strategic programmatic development, management of staffing, implementation and monitoring to meet all CM related Service Level Agreements (SLAs) for all Health System lines of business.
• They will collaborate with the finance department to develop a budget. They will plan and execute the departmental strategy within the budgetary constraints.
• The Director serves as a primary liaison between the CM team and internal or external stakeholders, including our network of providers, members and other community stakeholders.