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Medix™ · Garden City, New York
Job Title:
Director of Case Management (Registered Nurse)
Schedule/Shift:
Mon - Fri 9am-5pm EST
Hybrid; Garden City New York 11530
Pay:
$130,000-150,000
Strategic Leadership & Team Oversight:
Provide day-to-day oversight for Case Management operations (CCM, TOC, PHM); mentor, manage, and direct clinical staff; foster employee retention and high engagement.
NCQA Accreditation & Audit Readiness:
Oversee annual program evaluations, work plans, policies, and procedures; lead preparation for NCQA surveys, health plan audits, and regulatory reviews; maintain audit-ready documentation.
Clinical Operations & Program Execution:
Manage member identification, stratification, assessment, and individualized care planning (including social determinants of health); direct interdisciplinary care teams (nursing, social work, behavioral health, pharmacy, providers).
Quality Improvement & Metric Driving:
Utilize data analytics to identify care gaps; drive initiatives to lower avoidable admissions (ADK), emergency department visits (EDK), and readmissions; partner with Quality Management on performance improvement and corrective action plans.
Required Skills &
Licensure & Certification:
Current NYS RN License required; CCM (Certified Case Manager) certification required.
7+ years of progressive leadership experience in healthcare, managed care, or care coordination settings.
5+ years of experience in case management, discharge planning, or care transitions.
Demonstrated experience leading care management or utilization management teams.
Thorough knowledge of NCQA standards (Population Health Management, Complex Case Management, Transition of Care).
In-depth understanding of Medicare, Medicaid, Commercial, and Managed Care regulatory environments.
Experience managing delegated health plan programs and navigating delegation audits/regulatory examinations.
Understanding of utilization management, risk management, and compliance standards.
Strong clinical expertise in care coordination, complex case management, and discharge planning.
Data analytics proficiency to monitor program effectiveness, quality measures, utilization trends, and total cost of care.
Proven background in process improvement, performance optimization, and readmission reduction strategies.
Preferred Skills &
Competitive Compensation:
Base salary of $130,000 – $150,000 annually, plus eligibility for organizational performance bonuses.
100% Employer-Covered Health Benefits:
Fully paid Medical and Dental coverage for the employee, alongside a robust package including 401(k), PTO, FSA, and Tuition Reimbursement.
High-Impact Leadership Role:
Strategic oversight position managing programs across 125,000+ members in Commercial, Medicare, and Medicaid products.
Established Market Leader:
Part of the largest physician-owned and led IPA in the Northeast (active since 1996) with an expansive network of 6,000+ physicians.
Strong Focus on Culture & Quality:
High priority placed on employee satisfaction, retention, professional development, and delivering top-tier community healthcare in the New York area.
Details
| Company | Medix™ |
| Location | Garden City, New York |
| Type | FULL TIME |
| Niche | Full-time |
| Salary | $1,30,000 – $1,50,000 / yr |