Senior Director, Complex Care Management and Utilization Management

Job description

Position Summary The Senior Director, Complex Care Management (CCM) and Utilization Management (UM) is a strategic senior leader position that is responsible for designing, implementing, and optimizing integrated care delivery models that improve health outcomes for medically and socially complex populations. This role oversees the national CCM and UM programs, ensuring alignment with at-risk value-based care principles, transitional care management, regulatory compliance, and operational excellence across all markets. Experience with delegated care management and/or utilization management from a health plan is a major plus. Key Responsibilities: Strategic Leadership: -Oversee and responsible for efficient and effective use of the care and utilization management IT platform to drive improved population outcomes. -Experience with health plan delegated care management and utilization management services. - Lead the development and execution of enterprise-wide strategies for CCM and UM, integrating clinical, behavioral, and social determinants of health (SDoH) interventions. - Collaborate with executive leadership to align CCM/UM initiatives with organizational goals, payer contracts,...