Manager Disease Management & Wellness Programs
About The Position
Under the direction of the Director Care Management Programs, the Manager Disease Management and Wellness Programs is responsible for designing, implementing, and overseeing Disease Management and Wellness programs that promote member health, improve quality of life, and reduce healthcare costs across all lines of business. The role ensures programs meet the needs of members, providers, employer groups, and national accounts such as the Federal Employee Program (FEP). It oversees health interventions including digital tools, outreach campaigns, telephonic support, and community-based initiatives. The Manager oversees daily operations, program evaluation, and quality improvement activities, including URAC accreditation and HEDIS measures. The position manages staff, vendors, systems, budgets, and program performance, and collaborates with internal and external stakeholders. This position is eligible to work hybrid or onsite under the company’s Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
Requirements
- Bachelor’s degree in Nursing, Healthcare Administration, Health Services Management, Public Health, or a related field.
- Current, active, unrestricted Registered Nurse licensure in Kansas.
- At least 7 years of broad clinical experience in healthcare settings.
- At least 5 years of experience in the health insurance industry.
- At least 5 years in a management or leadership role.
- Knowledge of applicable state and federal requirements affecting health programs, including Kansas Insurance Department incentive guidelines and Federal Employee Program operational guidelines.
- Understanding of member and provider contracts across lines of business and how contractual requirements translate into program operations.
- Knowledge of healthcare accreditation and regulatory frameworks, including NCQA and URAC, and ability to interpret standards to support compliance and quality improvement.
- Knowledge of outcomes measurement methodologies, performance metrics, and quality reporting.
- Strong analytical and problem-solving skills, including the ability to interpret healthcare and program data to drive decisions.
- Excellent interpersonal skills and ability to build and maintain relationships with internal partners, external vendors, providers, employer group leaders, and members.
- Advanced written and verbal communication skills, including ability to present complex information clearly to diverse audiences.
- Ability to manage complex projects and competing priorities with attention to detail, adaptability to change, and focus on results.
- Ability to sit for extended periods while working at a computer, with intermittent standing and walking throughout the workday.
- Ability to communicate effectively in person and by phone or video conference, including participating in meetings for extended periods.
- Ability to occasionally lift, carry, push, or pull up to 25 pounds.
Nice To Haves
- Certification as a Case Manager (CCM).
- Certification as a Certified Diabetes Care and Education Specialist (CDCES).
- Additional certification in healthcare quality.
- Demonstrated experience applying statistical methods to quality management or healthcare research.
Responsibilities
- Manage staff and team operations, including hiring, performance management, policy enforcement, disciplinary action, termination processes, compliance, team development, and accurate documentation.
- Lead the design, implementation, and evaluation of disease management, wellness, preventive care, and chronic condition programs aligned with corporate goals and quality and accreditation standards such as HEDIS, URAC, and STARS.
- Analyze health risk, claims, and program data to guide population health strategies, prioritize initiatives, and inform program development and continuous improvement.
- Develop, validate, and monitor performance metrics, outcomes, and return on investment; prepare and present reports to internal committees and external stakeholders, including employer groups and national accounts such as FEP.
- Oversee department data systems and platforms, including vendor-supported tools, reporting capabilities, and IT project prioritization.
- Manage vendor relationships and contracts, including pricing, compliance, and performance guarantees; support accreditation readiness and reaccreditation activities.
- Coach, develop, and train a multidisciplinary team to execute program operations effectively, including outreach and engagement strategies.
- Escalate and resolve operational and interpersonal issues within the staff hierarchy and between clinical and non-clinical staff.
- Collaborate with providers, employer groups, community-based organizations, and internal teams; support RFP/RFI processes and represent the organization on external committees as assigned.
- Create and manage annual departmental plans and budgets of approximately $2 million.
- Ensure compliance with applicable laws and regulations, internal policies, HIPAA, safety standards, and information security requirements.
Benefits
- Incentive pay program (EPIP).
- Health, vision, and dental insurance.
- Six weeks of paid parental leave for new mothers and fathers.
- Fertility and adoption assistance.
- Two weeks of paid caregiver leave.
- 401(k) plan with matching up to 5%.
- Tuition reimbursement.
- Health and fitness benefits, discounts, and resources.
- Paid vacation and sick leave.
- Paid maternity and paternity leave available immediately upon hire.
- Ongoing training and development programs.
- Flexible work environment; position may be hybrid or onsite subject to company policy.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
