Director, Care Management (Healthtech)

TL;DR

Director, Care Management (Healthtech): Leading case and utilization management functions to ensure high-quality, medically necessary care for members with an accent on clinical strategy and cost containment. Focus on designing internal payer tools, evolving coverage guidelines, and managing high-cost claimant reviews.

Location: Must be based in the US

Salary: $155,000 - $175,000 per year

Company

hirify.global is a health plan solution built for small and midsize businesses, designed around an integrated primary care service to make healthcare easy and affordable.

What you will do

• Champion payer-side clinical strategy, ensuring evidence-based coverage policies and seamless member care.
• Build and lead a clinician-led team responsible for complex case management and utilization management.
• Drive strategy for cost containment initiatives, including benefit design and clinical partnership management.
• Partner with Underwriting and Analytics to assess clinical risk and support medical economics.
• Serve as the primary clinical voice in designing internal payer tools, coverage engines, and UM workflows.
• Establish case management KPIs and reporting structures to measure clinical efficacy and outcomes.

Requirements

• Valid license to practice as an NP, RN, PA, MD, DO or a Master’s in Healthcare Administration.
• 8+ years of experience in clinical care and payer-side population health (case/utilization management).
• Must be based in the US.
• Strong ability to make tradeoffs between cost, access, and clinical outcomes.
• Comfort working with analytics, SQL, and BI tools like Tableau or Mode.
• Experience operating in a fast-moving, ambiguous startup environment.

Culture & Benefits

• Fully distributed remote company with no return-to-office mandates.
• 100% company-paid employee coverage for medical, dental, and vision insurance.
• 401(k) with company match, plus FSA and HSA plans.
• Flexible vacation policy and a paid one-month sabbatical after 5 years of service.
• Full sponsorship for state licensure renewals and continuing education units (CEUs).
• Competitive stock options, home office stipends, and an ongoing learning budget.