Director of Care Management

Capital Blue Cross•Harrisburg, PA

8h•Hybrid

About The Position

The Director of Care Management delivers value to customers by leading the development and implementation of clinical intervention strategies tailored to the needs of defined populations. This role collaborates across care teams to identify optimal clinical support and programming, including integration of the clinical strategy to ensure alignment with organizational goals and population health priorities. The Director oversees clinically integrated programs for Capital members, leads operational and outcome improvement initiatives, and ensures clinical oversight for all member outreach and engagement programs. This individual plays a key role in deploying resources to support measurable improvements in health outcomes, member experience, and cost efficiency. The position shares responsibility for developing and executing an annual population health improvement plan, incorporating clinical strategy to assess intervention effectiveness, identify strategic opportunities, and design targeted solutions that support accreditation and compliance objectives.

Requirements

Possession of excellent leadership, analytical, and data management skills
Must have strong communication skills and have the ability to positively interact with personnel, customers, family members, visitors, contracted agencies/personnel and the general public.
Excellent verbal, public speaking and written communication skills.
Strong managerial and project management skills
Evidence of ability to analyze outcomes and develop goal-oriented action plans.
critical thinking, and problem-solving skills
Ability to operate a personal computer and proficiency in various Microsoft Office applications including Word, Excel and Outlook.
Ability to appropriately prioritize workload and assignments.
10+ years of experience with clinical healthcare
5+ years of experience with healthcare delivery program management and administration
5+ years of experience with project management, process improvement, quality improvement, or organizational design
Experience with Microsoft Office, including Word, Excel, PowerPoint, and Outlook
Knowledge and experience with remote patient monitoring
At least 3 years of clinical experience.
5 years of successful, progressive managerial experience is required.
Must possess an active RN license in the required state and a valid driver's license.
Possession of a valid driver’s license and the ability to travel to support program operations, speaking engagements and client meetings.
The employee must be able to work over 40 hours per week.

Nice To Haves

Experience in working in complex matrixed environments
Prior analytical experience preferred
A Master’s degree in a health or business-related field is preferred.

Responsibilities

Develop and evolve the population health strategy framework for member/patient management and engagement across the continuum of care, recommending interventional strategies as well as operational efficiencies to produce measurable outcomes.
Identify customer KPI’s and manage program operations to deliver customer defined results.
Provide day to day leadership, direction, guidance, clinical expertise and consultation to the population health clinically integrated program staff.
Support culture change and transformation activities with the clinical team
Advise on clinical operations improvement internally and externally
Support the dissemination of technology and clinical solutions across clinical staff
Analyze population performance and advise on best actions for improvement
Advise on and participate in company strategy and product roadmap, providing clinical insight and requirements on market changes and client needs
Develop and maintain knowledge of contract(s) with customers, as well as working relationship(s) to foster collaboration in data sharing, care coordination, population health management and outcome improvement.
Actively participate in product enhancement
Ensure appropriate policies and procedures and controls are in place to support all population health activities, maintain compliance and support the continued success of program accreditation.
Work with the leadership to support collaboration and provide clinical support to all of the programs across the population health continuum including remote monitoring interventions.
Prepares staffing models and updates as necessary
Identifies and reports potential quality of care issues in accordance with established departmental policies and procedures.
Maintains Member confidentiality at all times.
Shows sound judgment that affirms the rights and responsibilities of patients/participants, families, health care professionals and health care organizations.
Understands and complies with NCQA, CMS, ERISA, Act 68 and all applicable requirements.
Prepares operational budget and updates as necessary to monitor and manage operational costs
Monitors Key Performance indicators and takes actions to continually improve results
Attends company and departmental meetings and training sessions as required.
Offers suggestions for improvement in departmental processes and identifies opportunities for new knowledge and approaches.
Represents organization’s interests at local, state, national and international meetings.
Makes formal presentations to large and small audiences.
Ability to facilitate in-person and virtual meetings with clients