Director, Care Management Full Time

This role is a senior clinical leadership position focused on transforming how care is managed within a modern health plan environment. You will lead the design and execution of case management and utilization management strategies to ensure members receive high-quality, evidence-based, and cost-effective care. Operating at the intersection of clinical practice and payer operations, you will help translate medical necessity, coverage policies, and population health insights into real-world member outcomes. The position requires close collaboration with cross-functional teams including operations, underwriting, analytics, product, and care delivery teams. You will play a key role in shaping clinical and cost strategies that directly influence affordability, access, and quality of care. This is a high-impact opportunity for a clinically grounded leader who wants to improve healthcare experiences at scale.

Accountabilities

• Lead the payer-side clinical strategy, ensuring coverage policies, utilization management decisions, and clinical guidelines are evidence-based and aligned with high-quality member care.
• Build and manage a clinician-led care management function focused on complex case management, utilization review, and high-cost patient oversight.
• Develop and implement cost containment and value-based initiatives that improve outcomes while maintaining affordability and reducing unnecessary care variation.
• Define and evolve coverage policies, benefit structures, and formulary guidelines in alignment with clinical best practices and business goals.
• Collaborate with pharmacy partners to design programs that control drug spend while maintaining adherence and minimizing member friction.
• Partner with underwriting, actuarial, and analytics teams to evaluate clinical risk, support pricing strategies, and generate actionable population health insights.
• Work closely with network, product, and care delivery teams to identify gaps in care and inform contracting and service design decisions.
• Serve as a clinical expert in the development of internal payer tools, workflows, and decision-support systems.
• Establish performance metrics for care management programs and continuously evaluate clinical outcomes, cost efficiency, and member impact.

Requirements

• Active clinical license (NP, RN, PA, MD, or DO) and/or Master’s degree in Healthcare Administration or related field.
• 8+ years of experience combining hands-on clinical practice with payer-side experience in case management, utilization management, or population health.
• Strong understanding of healthcare delivery, clinical decision-making, and payer operations, with the ability to balance cost, quality, and access.
• Experience working in or with startup or fast-paced healthcare environments is highly desirable.
• Strong analytical mindset with comfort working with data, reporting tools, and basic analytics platforms.
• Ability to communicate complex clinical and financial concepts clearly across clinical, technical, and business stakeholders.
• Demonstrated ability to build programs, processes, or teams from the ground up in evolving environments.
• Strong judgment, adaptability, and comfort operating with ambiguity in a rapidly changing organization.
• Excellent collaboration, communication, and stakeholder management skills.
• Deep motivation to improve healthcare systems and deliver better outcomes for members and employers.

Benefits

• Fully remote-first organization with no office return requirements.
• Comprehensive medical, dental, and vision insurance with 100% employee coverage.
• Flexible vacation policy and strong emphasis on work-life balance.
• 401(k) retirement plan with company match, plus FSA and HSA options.
• Paid parental leave and disability/life insurance coverage.
• Equity (stock options) offered to all employees.
• Continuing education support, including licensure renewal and CEU sponsorship.
• Home office setup stipend and ongoing learning and development budget.
• Paid sabbatical after five years of service.
• Transparent compensation structure with clear career development pathways.
• Competitive base salary ranging from $155,000 to $175,000 plus equity.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role’s core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

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