Care Management Director

Care Management Director

Summary of Position:

We are seeking an experienced Care Management Director to lead and oversee care management operations, drive performance, and support population health initiatives. This role is responsible for team leadership, operational oversight, and ensuring compliance with regulatory and accreditation requirements.

Key Responsibilities:

• Lead the development of analytics and business intelligence to support population health and market growth initiatives.
• Collaborate with senior leadership on the care management strategic plan and operational execution.
• Direct the hiring, onboarding, training, and performance management of care management staff.
• Oversee day-to-day care management operations, ensuring quality, compliance, and efficiency.
• Provide education, coaching, and mentoring to team members to improve performance.
• Identify and resolve operational and clinical issues using strong problem-solving skills.
• Act as a liaison between internal teams and external stakeholders to support care management initiatives.
• Address audit findings and implement performance improvement strategies.
• Ensure adherence to policies, procedures, and regulatory mandates.
• Collect and analyze program metrics, including oversight of HEDIS/STARS and NCQA requirements.

Principal Accountabilities:

• Manage daily operations of the care management team, including performance metrics, productivity, and workload distribution.
• Train and mentor employees, serving as a preceptor for new staff.
• Conduct staff evaluations and monitor team caseloads to meet organizational needs.
• Ensure accurate and timely clinical documentation in compliance with accreditation standards.
• Support care across the continuum, including behavioral health needs.
• Serve as a clinical resource and participate in care management rounds.

Qualifications:

• Bachelor s degree, preferably in Nursing.
• Current, unrestricted New York State RN license (required).
• CCM certification required (candidates enrolled in certification will be considered).
• 10+ years of relevant healthcare experience, including at least 5 years of clinical practice.
• Prior health plan and care management leadership experience preferred.
• Knowledge of population health management strategies.
• Strong organizational, problem-solving, and communication skills.
• Proficiency in Microsoft Office (Excel, PowerPoint).

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.