Director of Medical Management

Overview

UNITE HERE HEALTH seeks a Director of Care Navigation & Medical Cost Management to lead a multidisciplinary team of Navigators. The role focuses on improving member outcomes, reducing healthcare costs, addressing high-cost conditions, reducing emergency room utilization, and enhancing care coordination across the network. The Director collaborates with internal departments, providers, vendors, and health centers to implement data-driven, member-centered programs that support value-based care and health equity.

• Lead and manage Health Navigator and Nurse Navigator teams to ensure effective care coordination and cost mitigation strategies.
• Develop and oversee programs targeting high-cost members, providers, and chronic conditions, with a focus on diabetes and ESRD.
• Collaborate with utilization management (UM) vendors and internal teams to optimize site-of-care decisions and prior authorization protocols.
• Partner with Claims, Analytics, and Healthcare Delivery teams to analyze medical and pharmacy claims data and identify actionable cost drivers.
• Support network management efforts by guiding members to in-network providers and reducing unnecessary emergency room visits.
• Work with health centers, providers, and community organizations to promote coordinated care and reduce healthcare disparities.
• Monitor program effectiveness through ROI metrics, member outcomes, and cost trend analyses.
• Ensure compliance with HIPAA, payer guidelines, and internal policies.
• Provide strategic input on benefit design and policy development based on cost and utilization trends.
• Communicate program goals, outcomes, and opportunities to executive leadership and key stakeholders.
• Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints.
• Supervise, lead, delegate work, and coach, mentor, and develop employees.
• Analyze problems, identify and develop alternative solutions, project consequences of proposed actions, and implement recommendations/solutions.
• Recommend hires and promotions, direct, and evaluate employment decisions for all assigned positions.
• Assist with developing and coordinating policies and procedures.
• Oversee continued employee training requirements, safety, and quality initiatives.

• 7 to 10 years of DIRECT OR RELATED experience minimum.
• Bachelor’s Degree in Nursing (BSN) required;
  Master’s Degree in Healthcare Administration (MHA), Public Health (MPH), or Business Administration (MBA) preferred.
• Active Registered Nurse (RN) license required.
• Minimum of 7 years of experience in medical cost management, care coordination, or utilization management.
• Strong knowledge of managed care principles, value-based care, and healthcare cost-containment strategies.
• Understanding of self-funded health plans.
• Experience with chronic disease management programs, especially diabetes and ESRD.
• Proficiency in healthcare analytics platforms and data interpretation.
• Excellent leadership, communication, and strategic planning skills.
• Familiarity with EHR systems, payer platforms, and UM software.
• Experience working with union populations or in a labor health fund environment is a plus.
• Bilingual language skills preferred.
• Remote position with occasional travel for provider meetings, member outreach, and strategic planning sessions.

Base pay range: $/yr - $/yr. Salary may vary based on relevant experience, qualifications, certifications, licenses, education, time in role, performance, business sector, and geographic location.

Monday through Friday, 7.5 hours per day (37.5 hours per week) as a flexible hybrid employee.

Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

• Director

• Full-time

• Health Care Provider
• Industries
• Hospitals and Health Care

Note:

Referrals increase your chances of interviewing at UNITE HERE HEALTH. Apply BELOW