Director of Case Management - 234778
hace 4 días
Garden City
Director of Case Management Location: Garden City, NY (Hybrid / On-site options available) Employment Type: Full-Time Compensation: $130,000 – $150,000 annually + Performance Incentive Eligibility Benefits: Comprehensive benefits package (100% employer-paid medical & dental options, PTO, 401(k) match, FSA, Tuition Reimbursement) About Us We are a premier, physician-led healthcare organization dedicated to delivering high-quality, cost-effective care to members across the region. Operating for over two decades, our network brings together thousands of primary care physicians, specialists, and clinical support professionals to manage care across Commercial, Medicare, and Medicaid lines of business. Driven by operational excellence and a patient-centered mission, our organization provides the strategic infrastructure, clinical management, and population health initiatives necessary to improve health outcomes and serve our local communities. Position Overview Under the direction of senior executive leadership, the Director of Case Management provides strategic guidance and oversight for all clinical management functions—including Case Management, Complex Case Management, Transition of Care, and Population Health Management. This leadership role is responsible for driving the performance, operational compliance, and continuous improvement of care management programs to align with organizational goals, industry best practices, and health plan contractual standards. The Director leads day-to-day operations, mentors clinical staff, drives audit readiness, and collaborates across interdisciplinary teams to optimize clinical quality, enhance member experience, and reduce unnecessary healthcare utilization (such as avoidable hospitalizations and readmissions). Key Responsibilities • Operational Leadership: Direct daily operations for clinical case management programs; set clear goals, ensure staff accountability, and foster a supportive environment that attracts and retains top talent., • Utilization & Care Optimization: Analyze operational reports to identify care gaps; drive targeted clinical initiatives to reduce avoidable hospital admissions, emergency department visits, and readmissions across multiple lines of business., • Accreditation & Compliance: Oversee program alignment with national quality standards (including NCQA) and regulatory mandates. Lead preparation for health plan delegation reviews, external audits, and regulatory examinations., • Program Strategy & Evaluation: Develop, update, and evaluate annual program descriptions, clinical policies, and work plans to ensure alignment with quality framework standards., • Quality Improvement & Analytics: Leverage data analytics to monitor program performance, evaluate clinical interventions, track member outcomes, and implement performance improvement plans in partnership with Quality leadership., • Interdisciplinary Care Coordination: Oversee cross-functional care teams (nursing, social work, behavioral health, pharmacy, and network providers) to deliver individualized care plans addressing clinical, behavioral, and social determinants of health (SDOH). Candidate Qualifications Education, Licenses & Certifications • Education: Graduate of an accredited nursing or healthcare program required; Master’s Degree preferred., • Licensure: Active Registered Nurse (RN) license required; BSN preferred., • Certification: Certified Case Manager (CCM) required. Professional Experience • 7+ years of progressive clinical leadership experience within healthcare, managed care, or care coordination environments., • 5+ years of hands-on experience in case management, discharge planning, or care transitions., • 3–5+ years of supervisory or line management experience leading clinical teams., • Proven track record in executing care transition models, process optimization, and hospital readmission reduction strategies., • Experience managing delegated health plan operations and participating in delegation/accreditation audits. Core Competencies • Regulatory Knowledge: Deep understanding of NCQA standards, managed care frameworks, and Medicare/Medicaid regulations., • Clinical Expertise: Strong proficiency in clinical assessment, complex case management strategies, and population health approaches., • Strategic & Analytical Mindset: Demonstrated ability to interpret healthcare metrics, track utilization trends, and translate data into actionable operational plans., • Communication & Collaboration: Outstanding interpersonal and leadership skills, with a track record of building effective relationships with internal teams and external healthcare partners. Compensation & Benefits • Base Salary Range: $130,000 – $150,000 per year (Commensurate with experience, qualifications, and internal equity), • Incentives: Bonus eligible based on organizational performance goals., • Benefits Package: Full suite of benefits including employer-covered medical and dental coverage options, paid time off, retirement savings plan, healthcare spending accounts, and professional development support. Equal Opportunity Employer Our organization is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, sex, national origin, age, disability, status as a protected veteran, or any other status protected by applicable law.
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