Director of Case Management - 259396

Job Title: Director of Case Management

Schedule/Shift: Mon - Fri 9am-5pm EST

* first 60 days = training, ON SITE

* after training, 3 days in office (Weds = non-negotiable), 2 days WFH

Location: Hybrid; Garden City New York 11530

Pay: $130,000-150,000

Responsibilities

• Strategic Leadership & Team Oversight: Provide day-to-day oversight for Case Management operations (CCM, TOC, PHM); mentor, manage, and direct clinical staff; foster employee retention and high engagement.
• NCQA Accreditation & Audit Readiness: Oversee annual program evaluations, work plans, policies, and procedures; lead preparation for NCQA surveys, health plan audits, and regulatory reviews; maintain audit-ready documentation.
• Clinical Operations & Program Execution: Manage member identification, stratification, assessment, and individualized care planning (including social determinants of health); direct interdisciplinary care teams (nursing, social work, behavioral health, pharmacy, providers).
• Quality Improvement & Metric Driving: Utilize data analytics to identify care gaps; drive initiatives to lower avoidable admissions (ADK), emergency department visits (EDK), and readmissions; partner with Quality Management on performance improvement and corrective action plans.

Required Skills & Qualifications

• Licensure & Certification: Current NYS RN License required; CCM (Certified Case Manager) certification required.
• Experience:
• 7 years of progressive leadership experience in healthcare, managed care, or care coordination settings.
• 5 years of experience in case management, discharge planning, or care transitions.
• 3–5 years in supervisory/line management roles overseeing clinical operations.
• Demonstrated experience leading care management or utilization management teams.
• Domain & Regulatory Knowledge:
• Thorough knowledge of NCQA standards (Population Health Management, Complex Case Management, Transition of Care).
• In-depth understanding of Medicare, Medicaid, Commercial, and Managed Care regulatory environments.
• Experience managing delegated health plan programs and navigating delegation audits/regulatory examinations.
• Understanding of utilization management, risk management, and compliance standards.
• Technical & Operational Skills:
• Strong clinical expertise in care coordination, complex case management, and discharge planning.
• Data analytics proficiency to monitor program effectiveness, quality measures, utilization trends, and total cost of care.
• Proven background in process improvement, performance optimization, and readmission reduction strategies.

Preferred Skills & Qualifications

• Education: Master’s degree preferred; BSN required
• Clinical Background: Direct acute care clinical experience preferred.

Selling Points:

• Competitive Compensation: Base salary of $130,000 – $150,000 annually, plus eligibility for organizational performance bonuses.
• 100% Employer-Covered Health Benefits: Fully paid Medical and Dental coverage for the employee, alongside a robust package including 401(k), PTO, FSA, and Tuition Reimbursement.
• High-Impact Leadership Role: Strategic oversight position managing programs across 125,000 members in Commercial, Medicare, and Medicaid products.
• Established Market Leader: Part of the largest physician-owned and led IPA in the Northeast (active since 1996) with an expansive network of 6,000 physicians.
• Strong Focus on Culture & Quality: High priority placed on employee satisfaction, retention, professional development, and delivering top-tier community healthcare in the New York area.