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The Jacobson Group · Denver, Colorado
NO C2C
Job Description
Care Management Operations Leader
The Jacobson Group is seeking an experienced Care Management Operations Leader for a contract opportunity with a managed care organization. This leader will oversee a department of approximately 40–50 employees, drive operational improvements, optimize HealthEdge utilization, and maintain regulatory compliance while supporting the team through organizational change.
Lead and support a department of 40–50 employees through organizational change, establishing priorities, maintaining accountability, and ensuring operational continuity.
Assess and optimize the HealthEdge platform to improve care management workflows, data utilization, staff productivity, and operational efficiency.
Oversee daily care management operations, coordinating member care across medical, behavioral health, provider, and subcontractor networks.
Ensure compliance with CMS, Medicaid, NCQA, state Department of Insurance, and contractual requirements across applicable lines of business.
Collaborate with medical leadership, compliance, quality, technology, data analytics, and other stakeholders to resolve challenges and advance departmental goals.
Monitor operational performance, quality metrics, and productivity indicators; analyze data and communicate findings and recommendations to senior leadership.
Support employee development, training, and performance while providing guidance to managers and staff on clinical, operational, and workforce challenges.
Oversee delegated vendors and programs to ensure compliance with contractual obligations, quality standards, and performance expectations.
Bachelor’s degree required.
Seven or more years of administrative experience within a managed care organization or health plan, including leadership experience.
Experience leading multidisciplinary clinical and non-clinical teams through organizational change.
Strong knowledge of care management principles, case management strategies, and healthcare operations preferred.
Familiarity with CMS, Medicaid, NCQA, state regulatory, and health plan accreditation requirements preferred.
Demonstrated ability to manage people and processes, solve complex operational challenges, and build relationships with internal and external stakeholders.
Proficiency in Microsoft Excel, including statistical formulas, pivot charts, and data visualization.
Ability to work Mountain Standard Time (MST) business hours.
Ability to work a hybrid schedule with onsite travel for up to one week per month, with some flexibility.
Care Management Operations
Managed Care and Health Plan Administration
Team Leadership and Change Management
HealthEdge Platform Optimization
Regulatory Compliance and Audit Readiness
Staff Development and Performance Management
Vendor and Program Oversight
Data Analysis and Microsoft Excel
Pay Range
$85/hour W-2
Contract duration: 2+ months
Hybrid schedule with onsite work required, up to one week per month
Medical insurance
Dental insurance
Vision insurance
401(k) retirement savings plan
Contact
Karrie Ruch
The Jacobson Group
kruch@jacobsongroup.com
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Details
| Company | The Jacobson Group |
| Location | Denver, Colorado |
| Type | FULL TIME |
| Niche | Managers |