Director of Care Management, Medicaid

Morgan Consulting Resources, Inc. has been retained by Community Health Plan of Washington to conduct the search for an experienced Director of Care Management, Medicaid. This is a remote position with periodic travel to the home office in Seattle.

About Community Health Plan of Washington

For nearly 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting their choices for health care. CHPW’s coverage is geared toward a model of care that treats the whole person and fosters trust, compassion, respect, and equality.

Mission: “Our mission is to deliver accessible managed care services that meet the needs and improve the health of our communities, and make managed care participation beneficial for community-responsive providers. We work for patients, and we work to help providers better serve those patients.

About the Director of Care Management, Medicaid

Reporting to the Senior Director of Care Management, the Director of Care Management, Medicaid is responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for the Medicaid line of business.

Position Responsibilities

• Oversees assigned programs, including development, audits, quality monitoring, and reporting
• Defines strategies for identifying and managing high-risk members
• Designs processes and goals for medical and behavioral health care management
• Partners with internal teams to analyze program effectiveness and guide interventions
• Leads development and analysis of care management metrics tied to organizational goals
• Identifies opportunities for improvement based on clinical and service data analysis

Essential Knowledge, Skills & Abilities

• Skilled in designing and launching new programs and teams
• Proven ability to lead large teams and drive results through others
• Experienced in testing and implementing innovative solutions for special populations
• Strong understanding of managed care components and their integration
• Applies quality improvement methods to enhance processes
• Creates a positive work environment with feedback and staff development

Required Qualifications

• Bachelor’s degree in nursing or a master’s degree in social work
• RN or LSWAA or LSWAIC in the state of WA, as applicable
• Case Management Certification (CCM or ACM or C-ASWCM or CMGT-BC)
• 5 years progressive experience working with medical or behavioral case management
• 7 years progressively responsible management experience in the areas of case management or population health or disease management

Compensation and Benefits

The Director of Care Management, Medicaid is eligible for a 15% annual incentive target based on company, department, and individual performance goals. The base pay offered will consider internal equity and may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. Expected pay range of $145,000-$165,000. Explore CHPW’s full benefits at https://chpwbenefitshub.com/.