Additional Information
MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.
VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.
Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.
HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.
JOB PURPOSE
The Senior Director of Population Health Management has operational and strategic oversight for Case Management, Care Coordination, Utilization Management, and the organization's Population Health Management strategy. This role is responsible for designing, executing, and continuously improving enterprise-wide programs that drive health outcomes, quality performance, and manage the overall medical expense of the organization. This leader translates regulatory guidance and clinical best practices into scalable care management, utilization management, and care coordination, delivering measurable results for members, providers, and the business.
ESSENTIAL JOB DUTIES
Strategy & Governance
- Serve as a key member of the executive leadership team, partnering across clinical, financial, and operational domains to design and implement clinically driven financial improvement strategies that optimize care quality, reduce avoidable costs, and sustain long term organizational performance.
- Develop the multi-year Population Health strategy and annual operating plan aligned to Alliant's strategic objectives.
- Establish policies, programs and standard operating procedures across Case Management, Utilization Management, and Care Coordination.
- Chair cross-functional steering forums; ensure clear decision rights, cadence, and accountability.
- Act as a strategic thought partner to the Sr Director of Data Governance, Risk Adjustment & Medical Economics on the development and implementation of a Medical Economics strategy for the organization.
Care & Utilization Management
- Oversee clinical programs: complex case management, disease management, transitions of care, and utilization management; ensure evidence-based protocols, appropriateness, and equity.
- Build referral pathways and reporting for specialty programs and ensure efficient vendor collaboration and notifications.
Provider & Member Quality Engagement
- Develop provider engagement strategies (scorecards, incentives, care gap workflows, clinical collaboration) in partnership with the Sr. Director of Data Governance, Risk Adjustment & Medical Economics to drive improvement in Alliant's medical trend.
- Lead the development of quality improvement initiatives that enhance member health outcomes and achieve measurable gains in HEDIS® performance, ensuring compliance with NCQA standards and successful annual audit outcomes.
Operations & Talent
- Lead day-to-day operations across PopHealth teams; drive capacity planning, workforce management, and continuous improvement.
- Maintains regular and predictable attendance
- Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
- Works to encourage and promote Company culture throughout the organization
- Other duties as may be assigned
Healthonellc · Dalton, GA