Rise Director (Director of High Intensity Population Management)

firsthand Health • Washington, DC

11d

About The Position

firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health.
firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI.
We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job—it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun.
The Rise Director is a senior clinical and operational leader responsible for managing total cost of care for the highest acuity of members in the state—individuals with the greatest medical, behavioral health, and social complexity and highest overall healthcare expenditures.
This leader functions as the strategic and operational case manager for the most complex members, ensuring rapid coordination, prioritized access, and delivery of high-value, high-quality care across the full continuum. The role is accountable for measurable reductions in hospitalizations, emergency department utilization, avoidable acute care spend, and inappropriate high-cost site-of-care utilization. This role reports to the Executive Director for the state.

Requirements

• 7+ years of experience in value-based care, population health, managed care, or complex care management.
• Clinical licensure (LCSW or RN, preferred)
• Deep experience and relationships across community providers and resources (i.e. housing, hospital case management / discharge planning, outpatient detox/rehab centers)
• Experience in Medicaid, dual-eligible, and/or serious mental illness populations
• Demonstrated experience managing high-cost, medically and behaviorally complex populations.
• Experience leading interdisciplinary healthcare teams.
• Strong understanding of total cost of care models, risk stratification, and utilization management.
• Proven success in reducing avoidable acute care utilization.
• Experience working across multiple provider markets within a state.
• Exceptional operational leadership and cross-functional collaboration skills, both virtually and in person.

Responsibilities

• Own financial and clinical outcomes for the highest-cost, highest-acuity members statewide.
• Develop and execute strategies to reduce avoidable hospital admissions, readmissions, emergency department visits, and unnecessary specialty and facility utilization.
• Directly manage a team of Peer Specialists dedicated to providing high-intensity, daily member engagement and support including, but not limited to, ensuring:
• Comprehensive care planning and prioritization so each Peer Specialist has a clear understanding of their priorities and work with their highest-acuity members
• Immediate response to clinical and social destabilization
• Clear task assignment across team roles
• Closed-loop communication
• Removal of barriers to care access including appointment delays, transportation challenges, medication access issues, and social determinants of health.
• Rapid transitions of care post-hospitalization with 24 hour follow-up protocols
• Make critical decisions on where the practice should invest resources (people, dollars) for the appropriate care to keep a high acuity member out of the hospital
• Ensure structured escalation pathways and rapid response protocols for social, medical and BH crises.
• Serve as operational lead and break down barriers in process and communication across firsthand’s internal care teams, including central health guides, psych NPs, SOAR specialists, and other care team members.
• Identify, evaluate, and prioritize partnerships with the highest value, highest quality providers across all markets in the state, including but not limited to emergency rooms and hospitals, community primary care and specialists, behavioral health services and community and social services
• Use cost, quality, and outcomes data to stratify provider performance and guide member referrals
• Coordinate expedited and prioritized access for highest acuity members to top-performing PCPs, BH specialists, specialty providers, outpatient detox and rehab providers

Benefits

• For full-time employees, our compensation package includes base, equity (or a special incentive program for clinical roles) and performance bonus potential.
• Our benefits include physical and mental health, dental, vision, 401(k) with a match, 16 weeks parental leave for either parent, 15 days/year vacation in your first year (this increases to 20 days/year in your second year and beyond), and a supportive and inclusive culture.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed
• Number of Employees: 11-50 employees