Director of Care Management, Medicaid

Morgan Consulting Resources, Inc.; Washington; Remote; USD 145,000 - 165,000; Full time

Job summary

A healthcare organization is seeking a Director of Care Management, Medicaid to oversee care management activities for Medicaid members. This role requires a Bachelor’s degree in nursing or a master's in social work, along with significant experience in case management. The position offers a competitive salary between $145,000 and $165,000, with remote work flexibility and comprehensive benefits including healthcare and retirement plans.

Benefits

Medical, Prescription, Dental, Vision coverage

401(k) with employer match

Time off including 17 days PTO

Qualifications

• Bachelor’s degree in nursing or a master’s degree in social work required.
• RN or LSWAA or LSWAIC in the state of WA, as applicable.
• Minimum 5 years experience in medical or behavioral case management.
• At least 7 years in case management or population health management.

Responsibilities

• Oversee care management activities for Medicaid members.
• Define strategies to identify and manage high-risk members.
• Partner with teams to analyze program effectiveness.
• Lead development of care management metrics tied to goals.

Skills

Program design and launch

Team leadership

Innovative solution implementation

Managed care understanding

Quality improvement application

Staff development

Education

Bachelor’s degree in nursing

Master’s degree in social work

Case Management Certification

Job description

Morgan Consulting Resources, Inc. has been retained by Community Health Plan of Washington to conduct the search for an experienced Director of Care Management, Medicaid . This is a remote position with periodic travel to the home office in Seattle.

About Community Health Plan of Washington

For nearly 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting their choices for health care. CHPW’s coverage is geared toward a model of care that treats the whole person and fosters trust, compassion, respect, and equality.

Mission: “Our mission is to deliver accessible managed care services that meet the needs and improve the health of our communities, and make managed care participation beneficial for community-responsive providers. We work for patients, and we work to help providers better serve those patients.

About the Director of Care Management, Medicaid

Reporting to the Senior Director of Care Management, the Director of Care Management, Medicaid is responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for the Medicaid line of business.

Position Responsibilities

• Oversees assigned programs, including development, audits, quality monitoring, and reporting
• Defines strategies for identifying and managing high-risk members
• Designs processes and goals for medical and behavioral health care management
• Partners with internal teams to analyze program effectiveness and guide interventions
• Leads development and analysis of care management metrics tied to organizational goals
• Identifies opportunities for improvement based on clinical and service data analysis

Essential Knowledge, Skills & Abilities

• Skilled in designing and launching new programs and teams
• Proven ability to lead large teams and drive results through others
• Experienced in testing and implementing innovative solutions for special populations
• Strong understanding of managed care components and their integration
• Applies quality improvement methods to enhance processes
• Creates a positive work environment with feedback and staff development

Required Qualifications

• Bachelor’s degree in nursing or a master’s degree in social work
• RN or LSWAA or LSWAIC in the state of WA, as applicable
• Case Management Certification (CCM or ACM or C-ASWCM or CMGT-BC)
• 5+ years progressive experience working with medical or behavioral case management
• 7+ years progressively responsible management experience in the areas of case management or population health or disease management

About CHPW’s Culture

“Our Mission is our North Star, an overarching purpose carried out through our strategic goals. Our Values, orient us toward them; they influence our behaviors, actions, and priorities. Values by their nature are aspirational and serve as core principles. They give us a sense of purpose and direction, setting the tone for our daily interactions with each other. We are committed to the ongoing process of making our values a lived reality by infusing them into all aspects of how we lead and work together. Our shared values include:

• We Center Our Communities

We support the communities we serve, our colleagues, and those we partner with, by giving each person what they need to thrive.

• We Aim Towards Justice

We champion inclusive behaviors to help build bridges across our differences in the pursuit of building fair systems and practices.

• We Build Trusting Relationships

We embrace collaboration by inviting in more voices, and actively listening to them, to improve our teamwork and achieve our goals.

• We Own Our Actions

We strive to do the right thing by holding ourselves accountable to the communities we serve, to each other, and to ourselves.

Compensation and Benefits

The Director of Care Management, Medicaid is eligible for a 15% annual incentive target based on company, department, and individual performance goals. The base pay offered will consider internal equity and may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. Expected pay range of $145,000-$165,000. Explore CHPW’s full benefits at https://chpwbenefitshub.com/ .

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty