The Director of Care Management is a population health leader accountable for both financial and clinical performance in a full-risk environment, with significant responsibility for strategy, talent development, and value-based outcomes.
Key responsibilities include strategic leadership and oversight for the development, implementation, and management of comprehensive care management programs and wrap around services. This role is responsible for reducing avoidable utilization to annual targets and improving clinical outcomes of high-risk patients.
This position extends beyond day-to-day operations and staff management, requiring ownership of total cost of care performance, value-based contract success, and organizational capability development.
Region level oversight of care management programs, including complex care management, transitions of care, utilization management integration, behavioral health coordination, social determinants of health initiatives, and high-risk member interventions.
You'll enjoy the flexibility to work remotely * from anywhere within the CST or EST time zones as you take on some tough challenges.
Position Highlights & Primary Responsibilities: Strategic Leadership- Accountable for building a high-performing leadership team capable of scaling and sustaining results
- Partner with executive leaders, physicians, payers, analytics teams, and operational stakeholders to drive value-based care transformation
- Create leadership succession plans and establish a solid management pipeline
- Provide executive oversight of care management operations while empowering leaders to manage daily execution
- Represent care management in executive committees, payer discussions, and strategic planning initiatives
Financial Accountability- Monitor and improve key financial metrics
- Own and drive performance against total cost of care targets and financial goals associated with full-risk populations
- Leverage data and predictive analytics to identify intervention opportunities that improve both clinical and financial outcomes
- Coach managers on performance management, strategic thinking, quality improvement, financial stewardship, and organizational leadership
- Develop performance dashboards and accountability structures for leaders and teams
Clinical Outcomes Leadership- Ensure evidence-based care management practices are implemented consistently across programs
- Develop and execute the care management strategy supporting full-risk, capitated, shared savings, and value-based reimbursement models
- Lead initiatives focused on chronic disease management, high-risk populations, behavioral health integration, transitions of care, and health equity
- Design scalable workflows and operating models that optimize care management effectiveness and efficiency
- Ensure compliance with regulatory, accreditation, payer, and organizational requirements
- Drive a data-informed culture focused on outcome achievement rather than activity completion
Optum NY/NJ was formed in 2022 by bringing together Riverside Medical Group, CareMount Medical and ProHealth Care. The regional alignment combines resources and services across the care continuum - from preventative medicine to diagnostics to treatment and beyond across New York, New Jersey, and Southern Connecticut. As a Patient Centered Medical Home, Optum NY/NJ can provide patient-focused medical care to the entire family. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Together, we're making health care work better for everyone.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Masters level degree (MSN or MBA or MHA)
- Bachelors level degree in nursing (BSN)
- 8+ years of progressive leadership in care management leadership, payor or provider value-based care
- 3+ years' experience in full-risk population management
- Significant experience in change management and driving operational excellence
- Demonstrated success related to creating and executing business strategies and driving results within a large, complex organization
- Demonstrated solid understanding of Medicare Advantage, Medicaid, Commercial Risk, ACOs, MSSP, and alternative payment models.
Preferred Qualifications:- 5+ years of managed care or full-risk population management (delegated medical management)
- Experience with being Accountable for populations under full-risk contracts exceeding 30,000+ lives.
- Experience leading with population health initiatives for employed and network/contracted providers
- Demonstrated success managing clinical and financial outcomes within full-risk or value-based reimbursement models.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
