Director, Care Management

Job Description

Job Description

Description:

The Director, Care Management is responsible for providing clinical expertise and guidance in support of Veracity’s medical management programs to promote the delivery of high quality, cost-effective medical care. This role oversees the Case Management and Precertification departments, ensuring alignment of activities across case management, utilization management, precertification review, and population health programs. The Director ensures compliance with regulatory requirements, supports staff performance and development, and collaborates with internal and external stakeholders to optimize member outcomes and client satisfaction.

Key Responsibilities

Leadership & Team Management:

• Supports the functions of disease management, case management, pre-admission reviews, utilization management, concurrent reviews and retrospective reviews.
• Provides clinical guidance into the development of the Veracity Care Solution programs.
• Provide daily supervision, coaching, and professional development for clinical staff.
• Collaborates with clinical team to achieve optimal patient outcomes.
• Reviews reporting of clinical activities including protocols and documentation.
• Oversee staff scheduling, workload allocation, and coverage planning.
• Conduct regular team meetings and performance evaluations.

Staff Development & Support

• Provide coaching, education, and training for Case Management Nurses and Precertification Nurses.
• Ensure team compliance with licensure, certification, and continuing education requirements.
• Assist in hiring, onboarding, and professional development planning.

Operational Oversight:

• Ensure timely and accurate processing of case assignments and clinical activities.
• Support high-quality patient access to services.
• Serve as the primary escalation point for complex member or provider issues.
• Oversee documentation quality and compliance.

Collaboration & Communication:

• Partner with clinical staff and leadership to support workflows.
• Ensure appropriate case routing to clinical teams or vendors.
• Facilitate communication with patients, brokers, employer groups, internal departments, and providers regarding case status, updates and patient needs.
• Support communication related to member care needs, treatment planning, and provider engagement.
• Represent the department in cross-functional meetings.
• Coordinate with stop-loss/reinsurance partners when high-cost cases require reporting or forecasting.
• Support the escalation and resolution of barriers, psychosocial issues, or gaps in care identified by clinical staff.

Quality Improvement & Reporting:

• Assist with departmental reporting and data analysis.
• Monitor adherence to clinical documentation standards, regulatory requirements, and HIPAA privacy rules.
• Identify operational gaps and lead process improvement initiatives.
• Contribute to policy, procedure, and training material development.
• General Responsibilities:
• Support special projects and organizational initiatives.
• Participate in meetings and maintain confidentiality per HIPAA.

General Responsibilities:

• Support special projects and organizational initiatives.
• Participate in meetings and maintain confidentiality per HIPAA.

Qualifications

• RN Or LCSW with a clear, active and unrestricted license within the United States
• A Bachelors (or higher) degree in a health-related field (Master’s preferred)
• 5+ years of experience in healthcare operations, managed care, benefits administration, or client/member services.
• 3+ years of supervisory or team leadership experience required.
• Minimum 10 years clinical experience
• Experience working in a managed care or commercial insurance setting preferred
• Strong Problem-solving skills are essential including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving medical/clinical issues and problems.
• Excellent typing, computer and documentation skills
• Ability to coordinate and communicate with a multidisciplinary team (internal and external)
• Ability to multi-task is essential

Key Competencies

• Clinical Leadership & Oversight – Ability to provide clinical direction across case management, navigation, precertification, disease management, and population health programs.
• People Leadership & Team Development – Experience supervising, coaching, mentoring, evaluating, and developing clinical staff while fostering a high-performance culture.
• Healthcare Operations Management – Ability to oversee daily clinical operations, workload distribution, staffing, scheduling, and service delivery.
• Care Management Expertise – Deep knowledge of case management, utilization review, concurrent review, retrospective review, and care coordination practices.
• Regulatory & Compliance Management – Strong understanding of HIPAA, clinical documentation requirements, licensure standards, and healthcare regulatory compliance.
• Quality Improvement & Process Optimization – Ability to identify operational gaps, implement process improvements, and support quality outcomes initiatives.
• Strategic Problem Solving – Demonstrated capability to analyze complex clinical and operational issues and develop effective solutions.
• Performance Management – Experience conducting performance evaluations, monitoring productivity, and ensuring accountability for results.
• Cross-Functional Collaboration – Ability to partner effectively with leadership, providers, vendors, employer groups, brokers, and multidisciplinary teams.
• Stakeholder Relationship Management – Skill in managing communications and resolving escalated issues involving members, providers, and clients.
• Communication & Influencing Skills – Strong verbal and written communication skills with the ability to facilitate discussions and drive alignment among stakeholders.
• Data Analysis & Reporting – Ability to interpret clinical and operational data, monitor trends, and support reporting and forecasting activities.
• Talent Acquisition & Workforce Planning – Experience supporting recruitment, onboarding, succession planning, and professional development efforts.
• Member-Centered Care Coordination – Commitment to improving member outcomes through effective care planning, provider engagement, and barrier resolution.
• Project & Change Management – Ability to lead special projects, support organizational initiatives, and manage change across teams and processes.
• Technical & Documentation Proficiency – Strong computer, documentation, and healthcare systems skills to ensure accurate clinical records and operational efficiency.
• Time Management & Multitasking – Ability to prioritize competing demands, manage multiple initiatives, and meet deadlines in a dynamic environment.
• Financial & Risk Awareness – Understanding of high-cost case management, stop-loss reporting, care utilization, and cost-effective healthcare delivery.

About OneVeracity

OneVeracity partners with brokers to help self-funded employers reduce medical and pharmacy costs without compromising care. It delivers Health Plan Solutions, VeracityRx, Care Solutions, and Onsite Health Centers in one integrated model that gives employers a clearer, more coordinated way to manage healthcare spend. The approach is grounded in three guiding principles: enhance care, reduce costs, and make it easy. Founded in 2019 and headquartered in Kennesaw, Georgia, OneVeracity is a privately held company that serves self-funded employers across industries including manufacturing, government, and professional services. Learn more at