Director of Case Management

About the role

A growing physician-focused healthcare organization in the New York metropolitan area is seeking an experienced Director of Case Management to lead a multidisciplinary clinical care management team. This is an opportunity for an experienced Case Management leader to step into a highly visible role overseeing a growing team and key programs across complex case management, transitions of care, and population health.

Responsibilities

• Providing daily leadership and oversight of a multidisciplinary Case Management team
• Leading, mentoring, and developing Nurse Case Managers and Social Workers
• Overseeing Complex Case Management, Transition of Care, and Population Health programs
• Ensuring effective care coordination across the continuum of care
• Developing strategies to reduce preventable admissions, emergency department utilization, and readmissions
• Overseeing member assessment, risk stratification, care planning, and engagement
• Ensuring compliance with NCQA, CMS, state/federal, and health plan requirements
• Leading preparation for accreditation reviews, health plan audits, and regulatory examinations
• Maintaining audit-ready program documentation, policies, procedures, and evaluations
• Monitoring clinical outcomes, utilization trends, quality measures, and program effectiveness
• Leading quality and process-improvement initiatives
• Collaborating with nursing, social work, behavioral health, pharmacy, physicians, and other clinical partners

Requirements

• Current RN license
• CCM certification required
• 5+ years of experience in case management, complex case management, discharge planning, or transitions of care
• 3–5+ years of clinical management or supervisory experience
• Experience leading Case Management and/or Utilization Management teams
• Managed care experience
• Strong understanding of Medicare, Medicaid, commercial, and managed care requirements
• Experience with regulatory compliance and healthcare audits
• Strong clinical, leadership, analytical, and communication skills

Qualifications

• BSN preferred
• Master's degree preferred
• Direct acute-care clinical experience
• Experience with NCQA Case Management, Population Health, and Transition of Care standards
• Experience managing delegated health plan programs and participating in health plan/delegation audits
• Population health experience
• Experience leading interdisciplinary teams that include both nursing and social work
• Experience with performance improvement and initiatives focused on reducing avoidable utilization

Benefits

• Strong medical and dental benefits (100% employer-paid employee medical and dental coverage)
• Bonus opportunity
• Growing clinical team with opportunity to shape and strengthen care management programs

Pay

$150,000–$160,000 base salary, based on experience and qualifications, plus bonus opportunity.

Schedule

Hybrid work environment.