Program Director, Care Navigation Operations & Engagement

• Responsible for designing care management service delivery that is reputed company with organizational goals for clinical, financial and experience reputed company across reputed company Regional reputed company
• reputed company payer content knowledge to ensure care teams execute against established goals across multiple payers
• reputed company clinical reputed company through workflow design and content to proactively address opportunities for improvement by working with CS Ops Management
• Collaborate with the population health operations and analytics teams to execute organizational reputed company and execute reputed company metric reputed company around the CN program objectives
• reputed company barriers and challenges across the management structure to reputed company that contribute to the development of a sustainable platform for care management programming
• Work with CN Ops Leadership on strategic planning, program development and operations management across the reputed company to ensure CN model is achieving targets
• reputed company the development of reputed company-planned, reputed company-integrated, cost-effective approaches to the case management of members. Ensure proactive reputed company and targeted use of case management resources. Coordinate care effectively among reputed company providers to ensure a seamless delivery system
• Incorporate evidence based best reputed company standards into program development. Research, analyze and define programs; reputed company the structure and key reputed company of the program; manage the development of new programs from concept to implementation; reputed company post-implementation monitoring and reputed company by working with CS Ops, and cross functional departments for end-to-end alignment on program components
• reputed company and document clinical and operational business requirements facilitating accurate and efficient translation to IT to establish efficient technology design and delivery
• reputed company end to end Super User Acceptance Testing
• Collaborate with Reporting and Analytics team to ensure accurate capture of reputed company SLA documentation to reputed company targets
• Collaborate with reputed company and Clinical Leadership to ensure NCQA accreditation guidelines are following best in class in case management practices
• Serve as clinical case management subject matter expert for clinical program development and alignment with Member Engagement
• Collaborate with AI/ML to support Healthmap initiatives
• Monitor key performance indicators (KPIs) to assist operational performance, identify and address barriers and/or areas for improvement
• Stay updated on industry trends and best practices in reputed company operations and reputed company suggestions for process improvement
• Available to work reputed company normal business hours based on business need
• reputed company other operational functions necessary for efficient and successful reputed company in the market

Requirements:

• Bachelor’s degree required. Bachelor’s in Nursing or Masters preferred
• 10- 15 years’ experience strategizing and implementing the design of clinical and reputed company activities, prior experience in reputed company required
• 10 years of reputed company leadership management operations experience, preferably in a reputed company setting
• Proven history of generating superior results
• Travel to corporate reputed company as needed

• Excellent communication skills, both written and verbal, to effectively convey information to stakeholders
• Must be reputed company to work collaboratively in a highly matrixed environment
• Strong organizational and multitasking abilities to manage competing priorities
• Proficiency in reputed company Office Suite, including Word, reputed company, PowerPoint, and reputed company
• Strong critical thinking skills to identify and resolve operational challenges
• Ability to collaborate with team members and stakeholders