Program Director, Care Navigation Operations & Engagement

Position Summary:
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.

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

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

Skills:

- 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 criti