Dir, Care Management Services

About Company:

Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.

We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.

Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.

We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:

• Medical, dental and vision insurance
• Paid time off for vacation, illness and volunteering
• Retirement savings plan with employer contribution
• Adoption financial assistance
• Paid parental leave
• And much more!

Comagine Health actively cultivates an organizational culture that fosters well-being and prioritizes engagement, connectedness and collaboration among team members.

Each employee's unique background, perspective and abilities are fundamental to the success of our mission and organization.

Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees.

About the Role:

Based on contractual obligation the person needs to reside in the Pacific time zone.

The Director of Care Management Services is a member of the Care Management leadership team. The Director works closely with Care Management and other corporate team members to direct and manage all aspects of assigned contract(s). The Director serves as the primary liaison with the client and works closely with the client to provide guidance to assist them with their business priorities and needs. The Director ensures services and deliverables are of the highest quality and of clinical integrity. The Director manages utilization and case management operations to ensure services meet contractual specifications, regulatory requirements, customer expectations, accreditation standards, and align with organizational mission, vision, and values. The Director identifies opportunities for new services and/or products to assist clients with their needs.

Minimum Qualifications:

• Bachelor's degree in Nursing.
• RN Licensure - Current, active, unrestricted
• Minimum of 7 years of clinical experience.
• 5 years of supervisory/management experience
• 5 years utilization management and/or case management experience
• Certification in Case Management (CCM).

• Strong knowledge of healthcare regulations, accreditation standards, and payer policies.

Preferred Qualifications:

• Master's degree in Nursing, Public Health, Health Administration, or a related discipline.
• 2 years demonstrated experience with government contracts administration.
• Experience or familiarity with behavioral health
• Experience with Medicaid programs
• Familiarity with the JIVA medical management application
• Familiarity with InterQual or other clinical decision support

Responsibilities:

• Oversee all personnel management activities, including supervision, evaluation, hiring and termination, in accordance with company policies
• Monitor staff and overall contract performance in the achievement of service delivery, quality, financial, and growth objectives
• Communicate and engage staff to achieve service, productivity, quality, financial and growth objectives in alignment with organizational mission, vision, and values
• Ensure staff have the training, tools, and support needed to perform daily work activities
• Develop, monitor, and report on department goals, standards, and objectives
• Implement operational policies, and procedures to meet contractual specifications, regulatory requirements, customer expectations, and accreditation standards
• Identify and oversee quality initiatives to improve operations
• Collaborate with medical affairs to develop guidelines and protocols for clinical review and case staffing
• Monitor, report, and interpret key operational and financial performance indicators and initiate timely corrective actions when indicated
• Maintain compliance with organizational policies and procedures
• Contribute to the development of budgets that achieve service delivery and performance objectives, contractual requirements, and financial goals
• Keep leadership informed of significant performance issues, quality initiatives, staffing concerns, and operational risks
• Advise clients to assist with their organizational priorities and identify new services to assist clients with their needs
• Participate in responses to requests for proposals, product development, and other business development activities

Skills:

The required skills enable the Director to effectively lead care management teams by applying clinical knowledge and administrative expertise to improve patient care coordination. Strong leadership and communication skills are essential for fostering collaboration among diverse healthcare professionals and stakeholders. Analytical skills are used daily to interpret data, monitor program outcomes, and guide decision-making processes. Knowledge of healthcare regulations ensures compliance and risk mitigation in all operational activities. Preferred qualifications such as Medicaid expertise and Jiva experience enhance the Director's ability to innovate and adapt services to evolving healthcare landscapes.

Compensation:

We value the opportunity to provide a remote work environment. Will this, we factor the cost of labor index.

Examples of location variations for pay:

Alaska: $153,000

Seattle, Washington: $153,000

Portland, Oregon: $132,000