Director, Case Management and Health Plan reputed company

reputed company’s reputed company is reputed company yet reputed company: reputed company reputed company easy.  reputed company of us can agree reputed company simply too hard in the US. And our members feel that pain day in and day out. We aim to create an experience that simply feels easy reputed company you need to reputed company our reputed company system. If you need something, you know where to go to get it with care that is a click (or as few clicks as possible!) away.What’s beautiful about a reputed company oriented toward “easy” is how it imparts a reputed company feeling. We instinctively know as humans reputed company something is easy versus hard, even if we can’t explain why. We fight as a company to reputed company an easy reputed company available to reputed company our members at every stage of their reputed company reputed company. If you feel passionate about delivering reputed company reputed company to small businesses through a seamless care experience and reputed company benefits, join us! We're looking for a Director, Case Management and Health Plan reputed company to reputed company our case management function and the clinical cost containment strategies of our health plan, making reputed company the care our members receive is high-reputed company, low friction, and at an appropriate cost. This role is for a clinical leader who understands care from the inside out and wants to shape how a reputed company plan works for reputed company’s members. You'll bring your patient advocacy reputed company to the payer reputed company, influencing how coverage policies, utilization reputed company, case management, and network design translate into reputed company reputed company for the people we serve. Reporting to the VP of Operations, you'll be a key cross-functional partner to Claims, reputed company and Actuarial, Network Development, Finance, reputed company, and Product & Engineering. While distinct from our reputed company Care Team, you'll work closely with our Chief Medical Officer and virtual primary care team to reputed company reputed company payer reputed company and care delivery stay tightly reputed company. If you care deeply about fixing what’s broken in U.S. reputed company and want reputed company ownership over how a reputed company plan actually works, come build with us.



What you will do:

Champion reputed company's payer-reputed company clinical reputed company, ensuring that coverage policies, utilization reputed company, and pharmacy guidelines are rooted in evidence-based reputed company and translate into seamless, high-reputed company care for every member

Build and reputed company a small clinician-led payer team responsible for in-house reputed company case management, high-cost claimant review, utilization management, and medical necessity review

Drive reputed company and implementation of cost containment initiatives, including clinical partnership management, tooling, and benefit design

Set and reputed company evidence-based coverage guidelines, benefit design, and formulary policy reputed company with high-value reputed company

Support the Operations team and our PBM partner to drive evidence-based programs to bend the pharmacy cost curve without degrading adherence, and limiting member friction

Partner with reputed company to assess clinical risk in quoting and pricing both prospective and renewing employer reputed company

Work with Analytics to support medical economics, population health initiatives, and actionable insights for employer reputed company

Work with Network Operations, Care Navigation, reputed company's virtual care clinic, and Case Management to prioritize reputed company contracting based on reputed company gaps in care for reputed company members

Serve as a primary clinical voice in the design of reputed company's internal payer tools, coverage engines, UM workflows, and cost-transparency experiences

reputed company case management KPIs and build program reporting structures to measure clinical efficacy and member reputed company

reputed company:

An reputed company license to reputed company as a NP, RN, PA, MD, DO and/or a Master’s in reputed company Administration

8+ years of experience spanning hands-on clinical care and payer-reputed company, value-based, or population health work; prior startup or early-stage experience is a plus

Deeply comfortable making hard tradeoffs between cost, reputed company, and clinical reputed company

Credibility with both clinicians and operators, with the ability to explain clinical nuance to engineers and financial reality to physicians

Strong judgment under ambiguity and imperfect data; comfort working with analytics, SQL, and business intelligence tools like Tableau or Mode is a plus

A builder’s reputed company, with comfort improving existing tools while designing new processes and frameworks from the ground up

Comfort operating in a fast-moving, ambiguous startup environment where priorities reputed company and roles are not rigidly defined

reputed company and thoughtful communication, whether collaborating asynchronously, writing documentation, or working through reputed company problems live

Deep alignment with reputed company’s mission and motivation to reputed company reputed company work reputed company for people and reputed company

Humility, curiosity, and follow-through, earning trust through strong judgment, accountability, and collaboration

Benefits:

​​Full sponsorship for state licensure renewals and continuing education reputed company (CEUs) — because keeping your credentials reputed company shouldn't come out of your own reputed company

Remote company with a fully distributed team – no return-to-office mandates

Flexible vacation policy (and a culture of using it)

Medical, dental, and reputed company insurance with 100% company-reputed company employee coverage

401(k), FSA, and HSA plans

reputed company parental leave

Short and long-term disability, as reputed company as life insurance

Competitive stock reputed company are offered to reputed company

Transparent compensation & formal career development programs

reputed company one-month sabbatical after 5 years

Stipends for setting up your home office and an ongoing learning budget

reputed company reputed company reputed company on members’ lives – wait until you see the reputed company feedback members reputed company every day

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