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Position Overview

The Director of Nurse Case Management is responsible for providing leadership and oversight in the Clinical Operations Department. This role ensures the delivery of high quality, cost effective case management services while maintaining compliance with company policies, customer expectations, and applicable regulatory requirements. The Director partners closely with the SVP of Clinical Operations, clinical teams, and key stakeholders to drive performance, quality outcomes, and departmental growth.

Key Responsibilities

• The Director of Nurse Case Management provides leadership and direction to Case Managers, Supervisors and their designated teams, ensuring day-to-day operations align with company and customer guidelines and expectations. This includes overseeing the assignment of referrals, ensuring timely and accurate time and notes entry into the case management database, and maintaining adherence to all Opus Medical guidelines and customer requirements.
• The Director is responsible for driving and managing the overall case management workflow, including reviewing documentation for accuracy, quality, and compliance. They conduct regular review of departmental reports, invoices, logs, and expense data on a daily, weekly, and monthly basis to monitor performance and identify areas for improvement.
• This role is responsible for upholding and enforcing compliance with all company policies and legal requirements regarding personal health information (PHI and IIHI). The Director ensures quality of service delivery across the department and oversees the resolution of client complaints and escalations.
• The Director manages human resources matters within the department, including performance management, coaching and development of supervisors, and partnering with HR on employee relations issues. They are responsible for fostering a culture of accountability, collaboration, and continuous improvement across the case management team.
• As a licensed RN, the Director provides clinical oversight and direction for case management clinical activities, ensuring nurses are practicing within scope and in accordance with nationally recognized standards of care. They serve as the clinical authority for the department and may provide guidance and direction to supervisors and case managers on complex referrals.
• Additional responsibilities may include participating in marketing and client support activities, attending client meetings, and representing the case management department in organizational and external initiatives. Travel may be required.

Leadership & Team Development

• Mentor and retain talent across the designated team.
• Cultivate a high-performance, collaborative, and inclusive team culture.
• Set clear performance expectations and support team development through coaching and feedback.
• Work independently while managing competing priorities across a distributed team.

Required Skills And Qualifications

The ideal candidate possesses a strong working knowledge of case management principles, workers’ compensation, and/or managed care options. They demonstrate the ability to lead, develop, and motivate a high-performing team in a fast-paced, remote environment. Strong analytical skills with the ability to interpret operational reports and drive informed decisions are essential. Excellent verbal and written communication skills are required, along with the ability to effectively manage relationships and resolve escalations professionally. Proficiency in case management platforms and Microsoft is expected. The Director must have a thorough understanding of HIPAA and all applicable regulations governing personal health information (PHI and IIHI).

Education

• Active Registered Nurse (RN) license in good standing required. A Bachelor of Science in Nursing (BSN) is required.
• Master’s degree in Nursing, Healthcare Administration, or a related field is preferred.
• Nationally recognized case management certification is preferred such as a CCM, ACM, or equivalent.
• Additional certifications in workers’ compensation, disability management, or utilization review are a plus.

Experience

• A minimum of 5-7 years of clinical nursing experience is required
• A minimum of 3-5 years in case management
• Supervisory or leadership experiences is preferred

Performance Metrics

Performance will be measured based on the following KPIs:

• Team retention, engagement, and performance outcomes
• Case assignment accuracy and timeliness
• Effective case processing within expected timeframes as well as report review completion on required schedules.

Work Environment & Location

• Remote with occasional travel as required for customer visits, team offsites, or industry events.
• Reports to: Senior Vice President (SVP) of Clinical Operations

Compensation & Benefits

• Competitive base salary + performance-based bonus
• Comprehensive benefits package (healthcare, 401k, PTO, etc.)
• Professional development and coaching opportunities