Director, Case Management

Job Description:‍

Department: Clinical Operations
Reports To: Vice President, Clinical Operations
FLSA Status: Exempt
Location: Hybrid, 2 days in office (Tuesday and Thursday in office 1460 Broadway, New York, NY), 3 days Remote

Position Summary

The Director of Case Management provides strategic and operational leadership for Antidote Health’s case management programs. This role oversees case management, behavioral health, disease management, and transitions of care, while serving as the primary liaison with delegated UM/CM vendors. The Director is responsible for ensuring members receive timely, appropriate, and coordinated care, while advancing quality outcomes, operational efficiency, and continuous compliance with NCQA accreditation and regulatory requirements.

Essential Duties and Responsibilities

Leadership & Staff Development

• Lead, supervise, and evaluate performance of supervisors and case management staff.
• Provide coaching, feedback, and recognition to foster engagement, accountability, and retention.
• Oversee recruitment, onboarding, and mentoring of staff.
• Establish ongoing training and professional development to ensure clinical excellence and compliance.
• Maintain staffing models that balance productivity, quality, and member experience.

Operations, Compliance & NCQA

• Direct day-to-day operations of case management, behavioral health, and disease management programs.
• Ensure documentation, workflows, and reporting comply with NCQA, CMS Marketplace, and state regulations.
• Conduct audits, identify gaps, and implement corrective action plans.
• Maintain continuous readiness for NCQA and regulatory audits.
• Develop, update, and enforce policies and procedures to support operational effectiveness.

Vendor Collaboration

• Act as primary point of accountability for delegated UM/CM vendors.
• Monitor vendor performance to ensure contractual and regulatory obligations are consistently met.
• Escalate performance issues and ensure timely corrective actions.
• Identify opportunities for process improvement and stronger vendor partnerships.
• Provide guidance, training, and feedback to vendors as appropriate.

Data Analytics & Reporting

• Oversee development and interpretation of utilization, quality, and productivity reports.
• Apply advanced Excel (pivot tables, advanced formulas, data modeling, dashboards) and analytics skills to manage large datasets and identify trends.
• Translate data insights into actionable strategies for program improvement.
• Deliver accurate, timely performance reports to leadership to support decision-making.

Collaboration & Integration

• Partner with internal stakeholders to align case management with organizational priorities.
• Support initiatives that improve health equity, quality, and member outcomes.
• Promote collaboration across clinical, behavioral health, pharmacy, and vendor teams to ensure continuity of care.
• Lead efforts to close care gaps and strengthen member engagement.

Supervisory Responsibilities

• Direct supervision of case management supervisors and staff.
• Oversight of delegated UM/CM vendor staff in collaboration with vendor leadership.

Qualifications

Required

• Bachelor’s degree in nursing (BSN required).
• Active, unrestricted RN license.
• Minimum 5 years of managed healthcare experience in case management, behavioral health, disease management, or care transitions.
• Supervisory/management experience in a managed care environment.
• Demonstrated expertise with NCQA accreditation standards and maintaining continuous readiness.
• Advanced proficiency in Excel and data analysis.
• Strong leadership, communication, and interpersonal skills with proven ability to lead through collaboration and influence.

Ideal Candidate

The ideal candidate is a leader who combines advanced clinical expertise with operational and regulatory leadership. They have:

• Education & Credentials: Degree in nursing and an active, unrestricted RN license in good standing.
• Accreditation & Compliance: Extensive experience leading programs through NCQA accreditation with a demonstrated ability to maintain continuous readiness and ensure compliance with federal, state, and contractual requirements.
• Program Leadership: Proven success directing integrated care management programs, including case management, disease management, behavioral health, and transitions of care.
• Vendor Oversight: A strong track record of holding delegated UM/CM vendors accountable, strengthening partnerships, and ensuring alignment with organizational and regulatory standards.
• Data Analytics: Expert-level ability to analyze and interpret complex datasets using advanced Excel and data modeling, and to translate insights into actionable strategies that improve outcomes and operational efficiency.
• Staff Development: Demonstrated success mentoring supervisors and staff, driving professional development, and maintaining high levels of employee engagement, retention, and performance.
• Results Orientation: Documented history of strengthening compliance, improving member outcomes, and achieving measurable performance targets in managed care environments.
• Leadership Style: Strong interpersonal and communication skills, with the emotional intelligence to lead through collaboration, influence, and accountability across clinical and operational teams.