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Role Description

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.

• Partner closely with the SVP of Clinical Operations, clinical teams, and key stakeholders to drive performance, quality outcomes, and departmental growth.
• Provide leadership and direction to Case Managers, Supervisors and their designated teams.
• Oversee the assignment of referrals and ensure timely and accurate time and notes entry into the case management database.
• Maintain adherence to all Opus Medical guidelines and customer requirements.
• Drive and manage the overall case management workflow, including reviewing documentation for accuracy, quality, and compliance.
• Conduct regular review of departmental reports, invoices, logs, and expense data to monitor performance and identify areas for improvement.
• Uphold and enforce compliance with all company policies and legal requirements regarding personal health information (PHI and IIHI).
• Ensure quality of service delivery across the department and oversee the resolution of client complaints and escalations.
• Manage human resources matters within the department, including performance management, coaching, and development of supervisors.
• Foster a culture of accountability, collaboration, and continuous improvement across the case management team.
• Provide clinical oversight and direction for case management clinical activities as a licensed RN.
• Participate in marketing and client support activities, attend client meetings, and represent the case management department in organizational and external initiatives.
• Travel may be required.

Qualifications

• Strong working knowledge of case management principles, workers’ compensation, and/or managed care options.
• 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.
• Excellent verbal and written communication skills.
• Ability to effectively manage relationships and resolve escalations professionally.
• Proficiency in case management platforms and Microsoft.
• Thorough understanding of HIPAA and all applicable regulations governing personal health information (PHI and IIHI).

Requirements

• Active Registered Nurse (RN) license in good standing required.
• 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.
• A minimum of 5-7 years of clinical nursing experience is required.
• A minimum of 3-5 years in case management.
• Supervisory or leadership experience is preferred.

Performance Metrics

• 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.

Compensation & Benefits

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