Senior Director, Care Management

NO C2C

Job Description

Care Management Operations Leader

The Jacobson Group is seeking an experienced Care Management Operations Leader for a contract opportunity with a managed care organization. This leader will oversee a department of approximately 40–50 employees, drive operational improvements, optimize HealthEdge utilization, and maintain regulatory compliance while supporting the team through organizational change.

Responsibilities

• Lead and support a department of 40–50 employees through organizational change, establishing priorities, maintaining accountability, and ensuring operational continuity.
• Assess and optimize the HealthEdge platform to improve care management workflows, data utilization, staff productivity, and operational efficiency.
• Oversee daily care management operations, coordinating member care across medical, behavioral health, provider, and subcontractor networks.
• Ensure compliance with CMS, Medicaid, NCQA, state Department of Insurance, and contractual requirements across applicable lines of business.
• Collaborate with medical leadership, compliance, quality, technology, data analytics, and other stakeholders to resolve challenges and advance departmental goals.
• Monitor operational performance, quality metrics, and productivity indicators; analyze data and communicate findings and recommendations to senior leadership.
• Support employee development, training, and performance while providing guidance to managers and staff on clinical, operational, and workforce challenges.
• Oversee delegated vendors and programs to ensure compliance with contractual obligations, quality standards, and performance expectations.

Requirements

• Bachelor’s degree required.
• Seven or more years of administrative experience within a managed care organization or health plan, including leadership experience.
• Three or more years of supervisory or management experience.
• Experience leading multidisciplinary clinical and non-clinical teams through organizational change.
• Strong knowledge of care management principles, case management strategies, and healthcare operations preferred.
• Familiarity with CMS, Medicaid, NCQA, state regulatory, and health plan accreditation requirements preferred.
• Demonstrated ability to manage people and processes, solve complex operational challenges, and build relationships with internal and external stakeholders.
• Proficiency in Microsoft Excel, including statistical formulas, pivot charts, and data visualization.
• Ability to work Mountain Standard Time (MST) business hours.
• Ability to work a hybrid schedule with onsite travel for up to one week per month, with some flexibility.

Key Skills

• Care Management Operations
• Managed Care and Health Plan Administration
• Team Leadership and Change Management
• HealthEdge Platform Optimization
• Regulatory Compliance and Audit Readiness
• Staff Development and Performance Management
• Vendor and Program Oversight
• Data Analysis and Microsoft Excel

Pay Range

• $85/hour W-2
• Contract duration: 2+ months
• Hybrid schedule with onsite work required, up to one week per month

Benefits

Our comprehensive benefits package includes:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Contact

Karrie Ruch

The Jacobson Group

View email address on click.appcast.io

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Know someone who may be a great fit? Contact Karrie Ruch or submit a referral through our referral form.