Director of Care Management

Job description :

At Quantum Recruiters we focus intently on providing talent to leading employers throughout the Pacific Northwest. For over 80 years, our client has built a reputation based on taking great care of people by delivering insurance plans to individuals and businesses throughout the Northwest. We are currently recruiting to fill a full time, contract Director of Care Management position within the healthcare industry.

• This is a 3-4 month contract position, and candidates can be located in Springfield, Boise, Bend or Portland, OR.

The Director of Government Care Management is responsible for leading, developing, and operationalizing care management / care coordination within the population health strategy for our Medicare (HMO, PPO) and Medicaid (5 CCO Regions). The Director of Care Management Government works within and across a matrixed environment to develop and lead a proactive and evolving care management strategy, incorporating performance improvement, regulatory adherence, accreditation, and Dual Eligible Special Needs Plan (D-SNP) Model of Care (MOC) compliance.

Essential Responsibilities :

Supporting Responsibilities :

SUCCESS PROFILE

Work Experience :   At least seven (7) years of experience with varied medical exposure required. Minimum of 3 years management or supervisory experience required. Knowledge and experience with Medicaid and Medicare clinical operations in health plans including medical management platforms, is required. Experience in case management, disease management, utilization management and program development using evidence-based medicine required. Prior success in healthcare integration, process development and program implementation is desirable. Additional experience managing complex work processes, including D-SNP, Medicaid, Medicare, Quality Programs (CMS Stars, OHA, NCQA) preferred.

Education, Certificates, Licenses :   Clinical Bachelor’s degree required. Registered nurse or behavioral health clinician with current unrestricted state license preferred. Master’s degree strongly preferred. Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) is strongly desired at time of hire. CCM certification required within two years of hire.

Job Types : Full-time, Contract, Temporary

Work Location : Hybrid remote in Springfield, OR 97477