Care Management Strategy & Operations Director Hybrid/Remote

Highmark; United States; Hybrid; USD 142,000 - 236,000; Full time

Job summary

Highmark Inc. seeks a strategic leader to develop and oversee a portfolio of care management and clinical programs across multiple markets. The role requires deep care management knowledge, financial acumen, and the ability to build high-performing teams to improve member and provider outcomes while controlling costs.

Hybrid or remote work is allowed; if near an office, onsite 3 days/week. The incumbent will drive strategic planning, ensure regulatory compliance, and report on KPIs to

Qualifications

• 7 years of experience in a healthcare setting.
• 7 years with Medicaid/DSNP in a multi-market environment.
• 5 years in a management or leadership role.
• 5 years of experience with diverse populations and care delivery models.
• Current RN licensure OR current multi-state licensure through eNLC OR Licensed Social Worker.
• CCM certification preferred.

Responsibilities

• Strategic Planning and Program Development: Develop and implement strategic and operational plans, including budget development and management, for designated service line(s), aligning with organizational goals and market trends.
• Perform management responsibilities to include hiring, coaching and development, rewards and recognition, performance management and staff productivity; manage to assigned budgets.
• Operational Management & Process Improvement: Oversee day-to-day operations, ensure resource allocation, implement quality control systems and lead process improvements.
• Clinical Program Oversight and Quality Assurance: Ensure delivery of high-quality care management programs, monitor compliance with clinical guidelines and regulatory requirements.
• Stakeholder Management: Build relationships with physicians, hospitals, community organizations, regulatory bodies, sales, and leadership to optimize care delivery.
• Performance Measurement & Reporting: Develop and monitor KPIs, report outcomes to leadership, and leverage data to improve engagement and outcomes.
• Other duties as assigned or requested.

Skills

Strategic planning

Leadership

Budgeting

Communication

Regulatory knowledge

Program evaluation

Performance improvement

Education

Bachelor's degree (Nursing / Social Work / Business / Healthcare Admin)

Master's degree preferred

Job description

Highmark Inc. seeks a strategic leader to develop and oversee a portfolio of care management and clinical programs across multiple markets. The role requires deep care management knowledge, financial acumen, and the ability to build high-performing teams to improve member and provider outcomes while controlling costs.

Hybrid or remote work is allowed; if near an office, onsite 3 days/week. The incumbent will drive strategic planning, ensure regulatory compliance, and report on KPIs to