Program Director, Care Navigation Operations & Engagement

Healthmap Solutions

11d•$130,234 - $200,248•Remote

About The Position

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.

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
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

Responsibilities

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