Portland, ME

This position serves as the leader for all clinical operations. The Director has primary responsibility to carry out all care coordination services. Accountabilities include all clinical operations, processes, programs, policies, procedures, documentation and reporting. Additionally, the Director participates with the Vice President of Health Management, Health Plan Medical Director, and other leaders to develop programs that support the success of all components of the Triple Aim. Care coordination activities include but are not limited to: health promotion and prevention, pre-admission planning, utilization management, discharge planning, transitions of care, case management, disease management and condition specific programs. Additionally, the Health Management Division provides expert clinical review of complex claims, reconsiderations and benefit interpretation issues or questions.

Direct Reports: 4+ Supervisors / Managers plus individuals


• Bachelor’s degree in nursing with Master’s degree in nursing or related field strongly preferred
• RN license
• Minimum of 8+ years of health care experience with 4+ years of leadership experience in a managed care setting, preferably in commercial and Medicare Advantage Plans
• Experience overseeing utilization management, case management and disease management required
• Experience using data and data analysis to design programs, manage care coordination services and measure success strongly preferred
• Experience managing external relationships with vendors, clients and physician partners strongly preferred
• Experience with health program strategy, design, implementation and evaluation preferred
• Experience applying CMSA, URAC and NCQA standards as well as State and Federal regulations preferred

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Contact us for more info:
Rebecka Boyd