Director of Population Health & Care Management

Director of Population Health & Care Management Confidential Springfield, MO Job Details Full-time | Contract | Internship $50,000 - $75,000 a year 3 hours ago Benefits Health savings account Flexible spending account Paid time off Employee assistance program Employee discount Professional development assistance Flexible schedule Qualifications Value-based care analysis Teamwork Skilled nursing facility experience Overseeing health insurance pre-certification Medicare HR communication Outpatient clinic experience Team leadership Health information compliance monitoring Healthcare documentation compliance audits Clinical staff development programs Long-term care facility experience Clinical staff training Medicare regulations Developing staff training programs as a care facility administrator Clinical documentation Centers for Medicare & Medicaid Services (CMS) billing regulations Technical skills instruction Medical Billing Certification Clinical documentation standards Healthcare coding investigations Internal audits Senior leadership Full Job Description Job Title Director of Population Health & Care Management (

Alternative Titles:

Care Coordination Senior Manager, Value-Based Care Director) Job SummaryWe are seeking an operational leader to oversee our care management teams across both clinic and long-term care (LTC) departments. This on-site role focuses on optimizing patient outcomes, ensuring 100% compliance, and maximizing revenue through value-based care programs. You will lead, train, and scale a team delivering critical Medicare services while managing daily clinical workflows, provider relations, and chart audits.

Key Responsibilities Department Leadership:

Manage care coordination across the outpatient clinic and long-term care facilities.

Staff Training:

Develop training protocols for staff on value-based care execution, CPT coding, and workflow efficiency.

Revenue & CPT Optimization:

Audit charts to ensure exact CPT code capturing and appropriate deployment of specialized value-based tracks, including:

Chronic & Complex Care:

CCM (Chronic Care Management), CPM (Chronic Pain Management), PCM (Principal Care Management), APCM (Advanced Primary Care Management).

Behavioral & Preventive Care:

BHI (Behavioral Health Integration), CoCM (Psychiatric Collaborative Care Model), CHI (Community Health Integration), PIN (Principal Illness Navigation), Annual Wellness Exams.

Transitions & Monitoring:

TCM (Transitional Care Management), RMT (Remote Therapeutic Monitoring).

Clinical Operations:

Supervise daily administrative tracks including prior authorizations, incoming faxes, and medical documentation.

Provider Relations:

Serve as the primary liaison between care management staff and clinic/LTC providers to streamline communication.

Quality & Outcomes:

Design workflows that directly improve resident outcomes, reduce readmissions, and boost preventive care compliance.

Software Management:

Utilize Tebra and Arsana daily, while evaluating integrations for MatrixCare and PointClickCare (PCC).

Position Details & Schedule Location:

On-site (potential to transition to a hybrid model in the future).

Schedule:

Flexible 4-day, 10-hour work week (4/10 schedule) available.

Required Qualifications Experience:

5+ years in healthcare management, with proven leadership in both clinic and long-term care / skilled nursing environments.

Technical Proficiency:

Experience with Tebra and Arsana is highly preferred. Familiarity with MatrixCare and PointClickCare (PCC) is a plus.

Clinical Billing Expertise:

Expert understanding of Medicare reimbursement rules, documentation guidelines, and CPT codes for complex, preventive, and remote care programs.

Core Skills:

Strong background in staff training, prior authorization workflows, provider communication, and financial chart auditing.

Pay:

$50,000.00 - $75,000.00 per year

Benefits:

Employee assistance program Employee discount Flexible schedule Flexible spending account Health savings account Paid time off Professional development assistance Application Question(s): Given our mix of CCM, PCM, and the new APCM codes, how do you determine which program is the most clinically appropriate and financially optimal for a patient with multiple severe chronic conditions?" When auditing a chart for Remote Therapeutic Monitoring (RMT) or Chronic Pain Management (CPM), what specific documentation details do you look for to ensure the note survives a Medicare audit? We use Tebra and Arsana, but need to bridge data with MatrixCare and PointClickCare (PCC) for our long-term care residents. Have you ever managed workflows across disparate EHR platforms, and how did you prevent data silos?" Many clinic and LTC staff view prior authorizations, faxes, and extensive care notes as administrative burdens. What training strategies do you use to get staff to properly document care gaps without causing burnout?"

Work Location:

In person