Associate Director responsible for programmatic strategy and performance oversight at GALE. Leading cross - functional collaboration to drive innovative programmatic solutions.
MC
Hybrid Director, Clinical Programs, Health Plan
Posted 2 months ago
About the role
- Provide strategic leadership for Utilization and Care Management programs that impact member health and well-being
- Develop and implement new programs to improve population health and reduce costs with a focus on evidence-based care
- Oversee care management operations, from disease management programs (like CHF) to complex care coordination
- Drive results through data, KPIs, reporting, monitoring performance, regulatory compliance, and accreditation standards
- Collaborate across the enterprise, aligning with quality, compliance, and clinical teams to support STAR performance and CMS requirements
- Manage external partners and vendors to ensure seamless integration and strong performance
- Lead and develop a talented team and work closely with senior health plan leaders
Requirements
- A clinical background (RN, NP, PA, PharmD, or similar licensure)
- A Bachelor’s degree in a clinical field (Master’s preferred)
- 10+ years of healthcare experience, including managed care, care/disease management, utilization management, and Medicare Advantage
- Demonstrated success in program design, implementation, and evaluation using data and analytics
- Strong project management skills and ability to lead through change in a matrixed environment
- Deep knowledge of Medicare Advantage, CMS Stars, HEDIS, accreditation standards, and regulatory requirements
- TRICARE experience a plus
- Ability to manage external partners and vendors
- Familiarity with KPIs, reporting, performance monitoring, and regulatory compliance
- Position is not eligible for immigration sponsorship (work authorization required)
Benefits
- organizational culture of trust and respect
- values - taking care of ourselves and others, continuous learning, helping each other, and having fun
- certified as a "Great Place to Work" since 2015
- opportunity to make a meaningful impact on members and health plan programs
- remote role with occasional travel to Portland, Maine
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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