Rise Director (Director of High Intensity Population Management)

The Rise Director is a senior clinical and operational leader responsible for managing total cost of care for the highest acuity of members in the state—individuals with the greatest medical, behavioral health, and social complexity and highest overall healthcare expenditures.

This leader functions as the strategic and operational case manager for the most complex members, ensuring rapid coordination, prioritized access, and delivery of high-value, high-quality care across the full continuum. The role is accountable for measurable reductions in hospitalizations, emergency department utilization, avoidable acute care spend, and inappropriate high-cost site-of-care utilization. This role reports to the Executive Director for the state. 

Core Responsibilities

As RISE director your responsibilities will include:

Total Cost of Care Accountability

• Own financial and clinical outcomes for the highest-cost, highest-acuity members statewide.
• Develop and execute strategies to reduce avoidable hospital admissions, readmissions, emergency department visits, and unnecessary specialty and facility utilization.

High-Intensity Care Team Leadership 

• Directly manage a team of Peer Specialists dedicated to providing high-intensity, daily member engagement and support including, but not limited to, ensuring:
• Comprehensive care planning and prioritization so each Peer Specialist has a clear understanding of their priorities and work with their highest-acuity members
• Immediate response to clinical and social destabilization
• Clear task assignment across team roles
• Closed-loop communication
• Removal of barriers to care access including appointment delays, transportation challenges, medication access issues, and social determinants of health.
• Rapid transitions of care post-hospitalization with 24 hour follow-up protocols
• Make critical decisions on where the practice should invest resources (people, dollars) for the appropriate care to keep a high acuity member out of the hospital
• Ensure structured escalation pathways and rapid response protocols for social, medical and BH crises.
• Serve as operational lead and break down barriers in process and communication across firsthand’s internal care teams, including central health guides, psych NPs, SOAR specialists, and other care team members.

Provider Network Optimization

• Identify, evaluate, and prioritize partnerships with the highest value, highest quality providers across all markets in the state, including but not limited to emergency rooms and hospitals, community primary care and specialists, behavioral health services and community and social services
• Use cost, quality, and outcomes data to stratify provider performance and guide member referrals
• Coordinate expedited and prioritized access for highest acuity members to top-performing PCPs, BH specialists, specialty providers, outpatient detox and rehab providers

You will be a good fit if you have:

• 7+ years of experience in value-based care, population health, managed care, or complex care management.
• Clinical licensure (LCSW or RN, preferred)
• Deep experience and relationships across community providers and resources (i.e. housing, hospital case management / discharge planning, outpatient detox/rehab centers)
• Experience in Medicaid, dual-eligible, and/or serious mental illness populations
• Demonstrated experience managing high-cost, medically and behaviorally complex populations.
• Experience leading interdisciplinary healthcare teams.
• Strong understanding of total cost of care models, risk stratification, and utilization management.
• Proven success in reducing avoidable acute care utilization.
• Experience working across multiple provider markets within a state.
• Exceptional operational leadership and cross-functional collaboration skills, both virtually and in person.