Job Description

Position Summary:

The Director of Care Management provides strategic leadership to identify market-level opportunities that optimize clinical cost management, improve care coordination, and elevate quality performance in a value-based primary care setting. This role is responsible for driving outcomes across transitions of care, utilization management, and quality improvement— particularly in alignment with HEDIS measures and CMS Star Ratings.

Location:

This is a hybrid position where the individual will split their time between working in our partner practices/office in Miamisburg, OH and remotely and must be based in the Miamisburg , OH area.

The Director leads a multidisciplinary case management team and collaborates closely with provider partners, payers, and internal stakeholders to create an integrated, high-performing care management and quality infrastructure. Programs and initiatives may range from moderately to highly complex and require hands-on engagement with executives, vendors, and clinical teams to implement innovative care models that improve patient outcomes and meet performance targets.

Essential Job Functions:

• Partner with the agilon health market leader to develop strategy and create priorities for executing operational work plan for the market.

• Leads a team of case managers, social workers and/ or support specialists, and collaborates with provider partners to define and measure case management program outcomes

• Develop and implement quality improvement initiatives to meet or exceed HEDIS and CMS Star Rating targets.

• Monitor and analyze quality performance metrics, identifying gaps in care and leading interventions to close them.

• Collaborate with clinical teams to ensure accurate documentation, coding, and reporting of quality measures.

• Provide project management support with minimal oversight, including managing day-to-day operations, maintaining work plans and timelines, preparing status reports, and ensuring project status is communicated to all stakeholders.

• Ensures the effectiveness of clinical initiatives, programs and preferred networks through the establishment of performance metrics and monitoring, measurement, and implementation of performance improvement strategies as indicated

• Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks.

• Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.

• Remain current on healthcare industry trends and value-based care models

• Active participation with data and analytics teams to identify opportunities

• Perform other duties as assigned

Other Job Functions:

• Understand, adhere to, and implement the Company's policies and procedures.

• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/ or external clients. Proactively ensuring that these needs are met or exceeded.

• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.

• Engage in excellent communication which includes listening attentively and speaking professionally.

• Set and complete challenging goals.

• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

1. Minimum Experience:

• 8 or more years of applicable experience in business, healthcare operations, project management, consulting or related experience required.

• Operational experience in a medical group or experience in operations improvement, healthcare consulting projects, client services, process development, program training, and enterprise analytics.

• Experience with Physician practice performance technologies and data systems preferred.

• Ability to multitask- Sense of urgency, prioritizing and maintaining a positive attitude.

• Ability to be proactive, take direction and establish ownership of projects.

• Demonstrated networking skills, able to foster strong relationships internally and externally.

• Strong customer focus; service-oriented attitude.

2. Education/Licensure: Bachelors required; Masters preferred. Current, unrestricted RN license required.

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