Director of Case Management Immediate Hire

Job description

-Must have an active RN licensed
-Lead case management, disease management, behavioral health, and transitions-of-care operations, including staffing, productivity, documentation quality, and member engagement.
-Serve as the internal subject-matter expert for QNXT and CCA, including workflow design, configuration support, testing, reporting, issue resolution, and user adoption.
-Hold delegated CM vendors accountable through performance monitoring, audits, scorecards, data validation, corrective action plans, and timely escalation.
-Maintain continuous readiness for NCQA, Marketplace, and state regulatory requirements, including organized evidence, policies, procedures, and audit files.
-Build and improve scalable workflows, controls, and reporting for a rapidly growing health plan; identify gaps and drive solutions without waiting for detailed direction.
-Use utilization, quality, productivity, and financial data to evaluate program performance, identify opportunities, and report results to leadership.
-Develop clear program descriptions, goals, outcome measures, and operating procedures, and ensure assigned deliverables are complete, accurate, and on time.
-Partner with Clinical Operations, Quality, Network, Claims, Product, IT, Compliance, and Vendors to improve care coordination and member outcomes.

• Remote Job
• Tele-Health
• Registered Nurse