Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The Director of Care Management delivers value to customers by leading the development and implementation of clinical intervention strategies tailored to the needs of defined populations. This role collaborates across care teams to identify optimal clinical support and programming, including integration of the clinical strategy to ensure alignment with organizational goals and population health priorities. The Director oversees clinically integrated programs for Capital members, leads operational and outcome improvement initiatives, and ensures clinical oversight for all member outreach and engagement programs. This individual plays a key role in deploying resources to support measurable improvements in health outcomes, member experience, and cost efficiency. The position shares responsibility for developing and executing an annual population health improvement plan, incorporating clinical strategy to assess intervention effectiveness, identify strategic opportunities, and design targeted solutions that support accreditation and compliance objectives.

• Develop and evolve the population health strategy framework for member/patient management and engagement across the continuum of care, recommending interventional strategies as well as operational efficiencies to produce measurable outcomes.
• Identify customer KPI’s and manage program operations to deliver customer defined results.
• Provide day to day leadership, direction, guidance, clinical expertise and consultation to the population health clinically integrated program staff.
• Support culture change and transformation activities with the clinical team
• Advise on clinical operations improvement internally and externally
• Support the dissemination of technology and clinical solutions across clinical staff
• Analyze population performance and advise on best actions for improvement
• Advise on and participate in company strategy and product roadmap, providing clinical insight and requirements on market changes and client needs
• Develop and maintain knowledge of contract(s) with customers, as well as working relationship(s) to foster collaboration in data sharing, care coordination, population health management and outcome improvement.
• Actively participate in product enhancement
• Ensure appropriate policies and procedures and controls are in place to support all population health activities, maintain compliance and support the continued success of program accreditation.
• Work with the leadership to support collaboration and provide clinical support to all of the programs across the population health continuum including remote monitoring interventions.
• Prepares staffing models and updates as necessary
• Identifies and reports potential quality of care issues in accordance with established departmental policies and procedures.
• Maintains Member confidentiality at all times. Shows sound judgment that affirms the rights and responsibilities of patients/participants, families, health care professionals and health care organizations.
• Understands and complies with NCQA, CMS, ERISA, Act 68 and all applicable requirements.
• Prepares operational budget and updates as necessary to monitor and manage operational costs
• Monitors Key Performance indicators and takes actions to continually improve results
• Attends company and departmental meetings and training sessions as required.

Skills

• Possession of excellent leadership, analytical, and data management skills
• Must have strong communication skills and have the ability to positively interact with personnel, customers, family members, visitors, contracted agencies/personnel and the general public.
• Offers suggestions for improvement in departmental processes and identifies opportunities for new knowledge and approaches.
• Represents organization’s interests at local, state, national and international meetings.
• Makes formal presentations to large and small audiences.
• Ability to facilitate in-person and virtual meetings with clients
• Possession of excellent oral and written communication skills
• Excellent verbal, public speaking and written communication skills.
• Strong managerial and project management skills
• Evidence of ability to analyze outcomes and develop goal-oriented action plans. critical thinking, and problem-solving skills
• Ability to operate a personal computer and proficiency in various Microsoft Office applications including Word, Excel and Outlook.
• Ability to appropriately prioritize workload and assignments.

Knowledge

• 10+ years of experience with clinical healthcare
• 5+ years of experience with healthcare delivery program management and administration
• 5+ years of experience with project management, process improvement, quality improvement, or organizational design
• Experience with Microsoft Office, including Word, Excel, PowerPoint, and Outlook
• Knowledge and experience with remote patient monitoring

Experience

• At least 3 years of clinical experience.
• 5 years of successful, progressive managerial experience is required.
• Experience in working in complex matrixed environments
• Prior analytical experience preferred

Education, Certification, and Licenses

• Must possess an active RN license in the required state and a valid driver’s license. A Master’s degree in a health or business-related field is preferred.

Work Environment

• Office and client locations

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work involving significant periods of sitting, talking, active listening, typing and performing repetitive motions. Work requires ability to perform close inspection of written and computer-generated documents as well as a PC monitor. Travel involved between base office, other office locations and primary care offices.

Other

• Performs other related duties and assignments as directed.

Travel

• Possession of a valid driver’s license and the ability to travel to support program operations, speaking engagements and client meetings. Travel may expand nationally up to 25%.

Location

•  This position is classified hybrid, which requires onsite work in Harrisburg, PA on Tuesdays and Wednesdays.

 

 

 

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.    
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.