National Director, Complex Care & Utilization Management

AbsoluteCARE Medical Center & Pharmacy; Northern (KY); Hybrid; USD 150,000 - 210,000; Full time

Job summary

AbsoluteCARE Medical Center & Pharmacy in Kentucky seeks a Senior Director to lead Complex Care Management and Utilization Management across markets. You will design and optimize integrated care models, align with value-based care and regulatory standards, and drive operational excellence.

Responsibilities include program oversight, leadership of CCM/UM teams, stakeholder engagement with payers and health systems, and reporting to executives on strategic direction and outcomes.

Qualifications

• Bachelor’s degree in Nursing, Public Health, Health Administration, or related field required.
• Master’s degree preferred.
• 7–10 years in a Senior Director or VP role overseeing complex care management, transitional care management or utilization management in a managed care or at-risk value-based medical group environment.
• Proven track record of leading large-scale, multi-site clinical operations, driving cost savings, achieving affordability targets and improving patient outcomes.
• Willingness to travel across markets to interact with corporate leadership team, managers, and front-line staff.

Responsibilities

• Direct the implementation of high-intensity, member-centered care models that reduce avoidable utilization and improve quality of life.
• Leads conversations with medical economics on understanding the financial impacts of both care management and utilization management programs.
• Supports the build of useful daily management reports to help support local managers in managing their team’s productivity and effectiveness.
• Develops materials and leads a monthly overview meeting for key executives to talk about strategic direction of both CCM and UM programs and executes on the strategy.
• Ensure compliance with NCQA standards and other regulatory requirements for UM and care coordination services.

Skills

Leadership

Communication

Change management

Strategic thinking

Education

Bachelor’s degree in Nursing, Public Health, Health Administration, or related field

Master’s degree preferred

Tools

ZeOmega/Jiva EHR

Job description

AbsoluteCARE Medical Center & Pharmacy in Kentucky seeks a Senior Director to lead Complex Care Management and Utilization Management across markets. You will design and optimize integrated care models, align with value-based care and regulatory standards, and drive operational excellence.

Responsibilities include program oversight, leadership of CCM/UM teams, stakeholder engagement with payers and health systems, and reporting to executives on strategic direction and outcomes.