Director, Care Management & Population Health; Remote

Emblem Health is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, Emblem Health partners with top hospitals and doctors, including its own Advantage Care Physicians, to deliver quality, affordable, convenient care.

At over a dozen Emblem Health Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information,  .

Provide vision and leadership for Care Management, ensuring integration into Emblem Health’s broader population health strategy. Accountable for the execution of clinical programs with organizational goals in patient outcomes, quality measures, and financial performance.

Oversee the design, implementation, and ongoing improvement of care management workflows, ensuring compliance with CMS, NCQA and state specific guidelines. Oversight and evaluation of clinical processes to ensure continuous review and improvement of program(s) process workflows and adherence to NCQA and Regulatory requirements. Develop, implement and/or monitor standardized protocols for clinical and non-clinical team activities to operationalize integrated proactive care review and management of CM strategic plan.

• Assist in leading the strategic development and deployment of care management & population health programs to support Emblem Health’s membership.
• Collaborate with other functional areas within organization to ensure that care managers are implementing Emblem Health Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health plan’s mission, vision, purpose and value statement.
• Implement and maximize care management & population health programs.
• Manage the daily operations of the care management programs, including patient enrollment, monitoring protocols, escalation pathways, and reporting.
• Facilitate/promote problem identification, analysis and resolution within care management operations to improve member outcomes and/or experience.
• Hire, mentor, coach, and build a high performing multidisciplinary team culture that emphasizes accountability, patient-centered care, and professional development.
• Manage daily operations of the Care Management team (Managers and Care management team): define metrics; measure performance and productivity against standards; deploy strategies to improve performance.

Monitor care management performance including program adherence, compliance and optimization;

Monitor employees’ performance regularly and coach employees as needed including team caseloads, workloads and compliance with department and regulatory standards.

• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that accreditation and regulatory standards are met.
• Analyze data and identify trends monthly to ensure company expectations meet or exceed industry benchmarks and regulatory requirements. Address audit related findings and implement performance improvement strategies.

• CCM certified required, but consideration will be given for current enrollees/candidates
• 10 – 12+ years of relevant, professional work experience
• 5+ years’ experience in a Care Management leadership role in a Health Plan setting
• Additional experience/specialized training may be considered in lieu of degree requirement
• 5+ years of clinical experience
• 2 – 5+ years of Healthcare Strategy experience, preferably in a consultative setting
• Strong process & analytical skills; ability to articulate and define outcome measures that capture key performance metrics
• Exceptional communication skills (both written and verbal) with the ability to present information in a variety of different formats
• Strong problem solving and strategy execution abilities
• Able to analyze problems and deploy strategies to improve performance in collaboration with the leadership team
• Strong team, and staff development skills
• Proven leadership…