What are the responsibilities and job description for the Director of Case Management position at Everly Talent?
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.
- Hybrid work environment
- Strong medical and dental benefits
- Bonus opportunity
- Growing clinical team with opportunity to shape and strengthen care management programs
Job Description: The Director of Case Management will provide strategic and operational leadership for Case Management, Complex Case Management, Transition of Care, and Population Health Management programs.
Key responsibilities include:
- 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
Preferred 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
Compensation: $150,000–$160,000 base salary, based on experience and qualifications, plus bonus opportunity. Comprehensive benefits include 100% employer-paid employee medical and dental coverage.
Salary : $150,000 - $160,000