• 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

Requirements:

• 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

• 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