RN Case Management Director

Job Summary

Leading the RN-led Complex Care Management program, the contract-to-hire RN Case Management Director will oversee strategy, clinical workflows, and operational performance in a remote setting, ensuring adherence to NCQA standards and driving measurable outcomes for members and clients.

Key responsibilities

• Lead the strategy and operational performance of the RN-led Case Management program, focusing on scalability and compliance
• Translate NCQA accreditation standards into executable policies, procedures, and training, ensuring sustained adherence
• Oversee clinical practice standards and partner with cross-functional teams to optimize program measurement and performance

Required qualifications

• Active RN license with experience in case management and clinical leadership
• Strong understanding of NCQA accreditation standards and case management best practices
• Experience in operational management and program development within a healthcare setting
• Proven ability to lead cross-functional teams and manage complex projects
• Familiarity with analytics and performance measurement frameworks in healthcare