Role Description The Program Director of Case Management and Member Engagement (Care Navigation Operations & Engagement) collaborates with care services, clinical, and cross-functional leadership to develop, define, and execute strategies for Healthmap Care Management Programs. This ensures the programs engage members, follow clinical best practices, and achieve performance targets. - Responsible for designing care management service delivery that is aligned with organizational goals for clinical, financial and experience outcomes across all Regional Pods. - Leverage payer content knowledge to ensure care teams execute against established goals across multiple payers. - Drive clinical outcomes through workflow design and content to proactively address opportunities for improvement by working with CS Ops Management. - Collaborate with the population health operations and analytics teams to execute organizational strategy and execute quality metric outcomes around the CN program objectives. - Articulate barriers and challenges across the management structure to identify solutions that contribute to the development of a sustainable platform for care management programming. - Work with CN Ops Leadership on strategic planning, program development and operations management across the regions to ensure CN model is achieving targets. - Lead the development of well-planned, well-integrated, cost-effective approaches to the case management of members. Ensure proactive intervention and targeted use of case management resources. Coordinate care effectively among all providers to ensure a seamless delivery system. - Incorporate evidence based best practice standards into program development. Research, analyze and define programs; develop the structure and key elements of the program; manage the development of new programs from concept to implementation; provide post-implementation monitoring and oversight by working with CS Ops, and cross functional departments for end-to-end alignment on program components. - Gather and document clinical and operational business requirements facilitating accurate and efficient translation to IT to establish efficient technology design and delivery. - Lead end to end Super User Acceptance Testing. - Collaborate with Reporting and Analytics team to ensure accurate capture of Client SLA documentation to achieve targets. - Collaborate with Quality and Clinical Leadership to ensure NCQA accreditation guidelines are following best in class in case management practices. - Serve as clinical case management subject matter expert for clinical program development and alignment with Member Engagement. - Collaborate with AI/ML to support Healthmap initiatives. - Monitor key performance indicators (KPIs) to assist operational performance, identify and address barriers and/or areas for improvement. - Stay updated on industry trends and best practices in healthcare operations and provide suggestions for process improvement. - Available to work outside normal business hours based on business need. - Perform other operational functions necessary for efficient and successful growth in the market. Qualifications - Bachelor’s degree required. Bachelor’s in Nursing or Masters preferred. - 10-15 years’ experience strategizing and implementing the design of clinical and quality activities, prior experience in healthcare required. - 10 years of progressive leadership management operations experience, preferably in a healthcare setting. - Proven history of generating superior results. - Travel to corporate headquarters as needed. Requirements - Excellent communication skills, both written and verbal, to effectively convey information to stakeholders. - Must be able to work collaboratively in a highly matrixed environment. - Strong organizational and multitasking abilities to manage competing priorities. - Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook. - Strong critical thinking skills to identify and resolve operational challenges. - Ability to collaborate with team members and stakeholders. Working Conditions - All roles require: - Sitting - Ability to sit for extended periods stationary or while driving. - Dexterity/Effort - Repetitive motion for typing and/or texting; Good manual dexterity for handling packages, paperwork, operation of motor vehicles and/or electronic devices. - Sense Acuity - Ability to see/read computer monitors or other electronic devices. - Additionally, on-site or at location positions (ex. Mailroom, IT or Admin) may require: - Lift/Carry/Push/Pull - Occasional movement of equipment, or materials up to 50/75 Pounds. - Bend/Twist - Occasional bending, twisting, and stooping; Occasional need to kneel or crouch. - Additionally Traveling positions (ex. Field Care Navigators or Quality Practice Advisors) may require: - Sense Acuity - Ability to see/read road signs, maps, and electronic devices; Good visual acuity for driving, including peripheral vision and depth perception. - Environmental - Possible exposure to travel, traffic and/or other outdoor hazards; Possible exposure to various weather conditions, including extreme heat, cold, rain, and snow.