Senior Director, Care Management & Value-Based Care

Nearterm Corporation; Colorado; On-site; USD 180,000 - 230,000; Full time

Job summary

Nearterm Corporation is seeking a Sr Director of Care Management for a Health Plan multi-facility health system in Colorado. You will drive strategic care management initiatives and collaborate across Quality, Population Health, Utilization Management, Pharmacy and Compliance to advance value-based care and member outcomes.

The role requires leading CM teams, ensuring regulatory compliance across CMS/NCQA standards, and partnering with finance to align budgets with strategic goals.

Responsibilities

• Partner with Quality, Population Health, Utilization Management, Pharmacy, Provider Relations, Operations, Product Relations, Compliance and Medical Economics to execute organizational priorities.
• Drive measurable improvements in clinical quality, member experience, utilization management and cost containment.
• Ensure CM functions comply with CMS, NCQA, state and accreditation standards; support regulatory reviews.
• Lead multiple CM teams and collaborate with providers, members and external stakeholders.
• Develop CM vision and strategy with the Chief Medical Officer; manage staffing, implementation and SLAs.

Job description

Nearterm Corporation is seeking a Sr Director of Care Management for a Health Plan multi-facility health system in Colorado. You will drive strategic care management initiatives and collaborate across Quality, Population Health, Utilization Management, Pharmacy and Compliance to advance value-based care and member outcomes.

The role requires leading CM teams, ensuring regulatory compliance across CMS/NCQA standards, and partnering with finance to align budgets with strategic goals.