Director of Case Management

Director of Case Management | RN, CCM Location: Garden City, NY (Hybrid) Compensation: $135,000–$150,000 annually + Bonus Eligibility Employment Type: Direct Hire Schedule: Monday–Friday, 9:00 AM–5:00 PM Medix is partnering exclusively with an established, physician-led healthcare organization in the New York metropolitan area to identify an experienced Director of Case Management . This is a high-impact leadership opportunity for an RN with strong managed care experience, advanced knowledge of NCQA standards, and a proven track record of leading clinical teams and improving care management outcomes. Position Overview The Director of Case Management will provide strategic and operational oversight of Case Management, Complex Case Management (CCM), Transition of Care (TOC), and Population Health Management (PHM) programs. Reporting to senior clinical leadership, this individual will oversee clinical operations, guide interdisciplinary teams, ensure regulatory and accreditation compliance, and lead initiatives to improve member outcomes and reduce avoidable healthcare utilization. Key Responsibilities Lead daily Case Management operations, including clinical staff development, performance management, employee engagement, and retention. Oversee CCM, TOC, and PHM programs in accordance with NCQA standards and delegated health plan requirements. Manage NCQA accreditation preparation, annual program evaluations, policies, procedures, audits, and regulatory reviews. Direct interdisciplinary care coordination involving nursing, social work, behavioral health, pharmacy, and provider partners. Develop and execute strategies to reduce avoidable admissions, emergency department utilization, and hospital readmissions. Analyze clinical outcomes, utilization trends, care gaps, and program performance to drive quality improvement. Collaborate with clinical and quality leadership to strengthen operational effectiveness, regulatory compliance, and member outcomes. Required Qualifications Active RN license and Certified Case Manager (CCM) certification — both required. 7+ years of progressive leadership experience in healthcare, managed care, or care coordination. 5+ years of experience in case management, discharge planning, or care transitions. 3–5+ years of supervisory or clinical operations management experience. Demonstrated experience leading case management, care management, or utilization management teams. Strong knowledge of NCQA standards , particularly CCM, TOC, and PHM. Experience with delegated health plan programs, accreditation preparation, and regulatory audits . Knowledge of Medicare, Medicaid, Commercial insurance, and managed care regulations. Experience using clinical data and performance metrics to improve outcomes and reduce utilization. Preferred: BSN or Master's degree and direct acute care clinical experience. Compensation & Benefits $135,000–$150,000 annual base salary Eligibility for organizational performance bonuses 100% employer-paid medical and dental coverage for employees 401(k), paid time off, flexible spending accounts, and tuition reimbursement Direct-hire leadership opportunity with an established healthcare organization Work Arrangement The position is based in Garden City, NY , with an initial 60-day onsite training period. Following training, the schedule transitions to three days onsite and two days working remotely per week. Wednesday is a required onsite day. Qualified candidates are encouraged to apply through Medix for confidential consideration.