Remote Director, Care Management Strategy and Operations

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

Job summary

Highmark Health is seeking a strategic leader to develop and oversee the portfolio of markets and segments in comprehensive care management, disease management, and clinical programs. The role requires clinical expertise, strong analytics, and financial acumen to drive value and outcomes.

The position can be hybrid or remote with onsite requirements within 50 miles of an office three days a week. Travel up to 50% may be required.

Qualifications

• Bachelor’s degree required in a healthcare or related field.
• Master’s degree preferred in a related field.
• Current RN licensure or multi-state licensure via eNLC, or Licensed Social Worker.
• CCM certification preferred.
• 7 years of experience in a healthcare setting.
• 7 years with the designated service line (Medicaid, DSNP) in multi-market environments.
• 5 years in a management or leadership role.
• 5 years of experience with diverse populations and care delivery models.

Responsibilities

• Develop strategic and operational plans including budget management for designated service lines.
• Lead and develop high-performing teams delivering care management programs.
• Ensure regulatory compliance and financial performance across markets.
• Monitor KPIs and report progress to leadership.
• Oversee care management, disease management, and health coaching programs.
• Identify opportunities for process improvements and quality enhancements.

Skills

Strategic planning

Operational management

Leadership

Analytical skills

Budget management

Communication skills

Regulatory knowledge

Program evaluation

Performance improvement

Education

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

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

Job description

Highmark Health is seeking a strategic leader to develop and oversee the portfolio of markets and segments in comprehensive care management, disease management, and clinical programs. The role requires clinical expertise, strong analytics, and financial acumen to drive value and outcomes.

The position can be hybrid or remote with onsite requirements within 50 miles of an office three days a week. Travel up to 50% may be required.