Licensed Care Management Director

Job Summary

A company is looking for a Director, Care Management to lead case management and utilization management functions.

Key Responsibilities

• Champion payer-side clinical strategy to ensure evidence-based coverage policies and high-quality care
• Build and lead a clinician-led team for complex case management and utilization management
• Drive cost containment initiatives and support operations to enhance pharmacy cost management

Required Qualifications

• A valid license as a NP, RN, PA, MD, DO, or a Master's in Healthcare Administration
• 8+ years of experience in clinical care and payer-side population health work
• Strong judgment in balancing cost, access, and clinical outcomes
• Experience with analytics, SQL, and business intelligence tools is a plus
• Alignment with the mission to improve healthcare for individuals and employers