Director, Medical Case Management (Western Zone)

Director, Medical Case Management

AmTrust Financial Services is seeking a Director, Medical Case Management for the Western Zone. This senior leader will oversee approximately 40 clinical professionals, including four direct-report managers, and drive proactive, data-driven workers' compensation medical case management performance, clinical quality, operational consistency, and claim outcomes in a fast-paced, high-change environment.

Reporting to the Head of Managed Care and Clinical, the Director, Medical Case Management will lead Western Zone workers' compensation medical case management operations to improve claim outcomes, return-to-work results, medical management impact, quality, compliance, and team performance. This role requires a proactive leader who combines strong clinical judgment with analytical discipline, using data, dashboards, trends, and performance insights to anticipate issues, identify opportunities, drive action, and measure results. The Zonal Director will translate organizational strategy into clear, actionable plans; empower front line leaders and teams; drive adoption of standard practices; foster a high-accountability culture; and communicate the "why" behind decisions to support alignment, engagement, and sustained execution in a rapidly changing environment.

• Lead Western Zone workers' compensation medical case management operations, providing direction, coaching, and accountability for managers and clinical teams.
• Drive measurable, data-driven outcomes, including return-to-work results, claim duration, medical spend influence, nurse productivity, quality, staffing, compliance, and operational performance trends.
• Use analytics, dashboards, and performance reporting to identify trends, diagnose root causes, prioritize improvement opportunities, and hold leaders accountable for results.
• Anticipate emerging issues, risks, and performance gaps before they escalate, shifting the organization from reactive issue resolution to proactive performance management.
• Translate enterprise medical management strategy into zonal priorities, action plans, SOPs, workflows, and consistent execution expectations.
• Empower front line leaders by setting clear standards, strengthening decision-making, developing leadership capability, and holding teams accountable for results.
• Lead change management by communicating the "why," addressing barriers, and supporting successful adoption of new processes, tools, and expectations.
• Partner with Claims, Legal, Medical Strategy, Analytics, Compliance, Operations, and other stakeholders to align priorities and improve outcomes.
• Ensure effective quality assurance, regulatory compliance, treatment guideline adoption, escalation practices, and claim quality standards.
• Build a constructive, outcome-focused culture that promotes ownership, collaboration, innovation, continuous improvement, and strong talent development.
• Monitor legal, legislative, and jurisdictional developments that may affect managed care operations and coordinate appropriate business response.

• Active unrestricted RN license in California required; eligibility to obtain and/or renew a multistate license required.
• BSN required; MSN, MBA, MHA, or related advanced degree strongly preferred.
• Seven or more years of workers' compensation medical case management, managed care, utilization management, or clinical operations experience required.
• Five or more years of nurse leadership experience required, including experience leading managers, supervisors, or team leads strongly preferred.
• Experience in a workers' compensation insurance carrier, TPA, managed care organization, or multi-jurisdictional claims environment strongly preferred.
• Experience using operational data, clinical metrics, dashboards, or performance reporting to lead teams, improve execution, and drive measurable outcomes strongly preferred.
• Demonstrated success leading change, developing talent, managing front line leader performance, and building a culture of accountability.
• Proven ability to lead effectively in a fast-paced, high-change environment while maintaining focus, urgency, team alignment, and accountability.

Clinical, Analytical, Operational, and Leadership Expertise

• Strong knowledge of workers' compensation laws, regulations, case management practices, managed care requirements, treatment guidelines, quality assurance, and medical management practices.
• Proven ability to lead leaders, manage geographically dispersed clinical teams, and create consistent expectations across a complex organization.
• Strong analytical capability with the ability to use data, metrics, dashboards, and performance trends to create action plans that improve claim, clinical, operational, and team outcomes.
• Ability to challenge assumptions, ask insightful questions, connect clinical activity to business results, and convert analysis into practical execution.
• Strong change leadership skills, including the ability to communicate the "why," influence adoption, and sustain compliance.
• Proactive, forward-looking leadership style with the ability to anticipate needs, make timely decisions, and quickly adjust priorities as business conditions change.
• Excellent stakeholder management, communication, presentation, collaboration, negotiation, and analytical skills.
• Experience developing and implementing SOPs, policies, procedures, program improvements, and performance plans.
• Ability to foster a culture of ownership, accountability, innovation, teamwork, and continuous improvement.

Results-Driven

• Demonstrates a strong commitment to achieving ambitious goals and delivering exceptional results.
• Proactively identifies opportunities, addresses challenges, and drives initiatives forward with minimal direction.
• Brings a high level of energy, determination, and accountability in a dynamic, fast-paced environment.
• Continuously seeks opportunities to enhance processes, improve performance, and drive measurable outcomes.

Collaborative & Humble

• Builds strong partnerships by valuing collaboration and actively seeking diverse perspectives.
• Exhibits self-awareness and embraces feedback as a tool for continuous growth and development.
• Recognizes team contributions, shares credit for successes, and supports others in achieving collective goals.
• Approaches challenges with curiosity, openness, and respect, fostering an inclusive and positive work environment.

Strategic Thinker

• Anticipates future business needs and develops forward-looking solutions that align with organizational priorities.
• Connects daily responsibilities and decisions to broader business objectives and long-term strategy.
• Leverages data, market intelligence, and business insights to make informed, impactful decisions.
• Balances immediate priorities with long-term opportunities to drive sustainable business success.

AmTrust Financial Services