Director, Care Strategy & Operations - Hybrid/Remote

Highmark Inc; Pennsylvania; Hybrid; USD 142,000 - 236,000; Full time

Job summary

Highmark Health in Pennsylvania seeks a strategic leader to oversee care management, disease management, and clinical programs, shaping a 1–3 year vision with strong clinical and financial acumen. You will build high-performing teams delivering high-quality, cost-effective care that improves member outcomes.

The role supports hybrid or remote work with onsite 3 days a week within 50 miles of an office, and involves coordinating with physicians, hospitals, and community partners to drive

Qualifications

• 7+ years of healthcare leadership experience.
• Experience with Medicaid/DSNP in multi-market environments.
• Bachelor’s degree required; master’s preferred in a related field.
• Current RN licensure or social work license; CCM preferred.

Responsibilities

• Develop and manage strategic plans and budgets for care management programs.
• Lead care management teams to ensure high-quality, cost-effective outcomes.
• Monitor compliance with CMS, URAC, NCQA and other standards.
• Analyze data and report KPIs to leadership.
• Foster relationships with physicians, hospitals, and regulatory bodies.

Skills

Strategic leadership

Healthcare administration

Budget management

Stakeholder engagement

Data analysis

Regulatory compliance

Education

Bachelor’s degree in Nursing, Social Work, Business, Healthcare Administration, or related field

Master’s degree in Nursing, Social Work, Business, Healthcare Administration, or related field

Job description

Highmark Health in Pennsylvania seeks a strategic leader to oversee care management, disease management, and clinical programs, shaping a 1–3 year vision with strong clinical and financial acumen. You will build high-performing teams delivering high-quality, cost-effective care that improves member outcomes.

The role supports hybrid or remote work with onsite 3 days a week within 50 miles of an office, and involves coordinating with physicians, hospitals, and community partners to drive