Director of Medicare Case Management
RCM Health Care Services, New York, NY, United States
Director of Case Management – Medicare (Hybrid | NYC)
Location: Manhattan (2 days onsite / 3 days remote)
Salary: $160,000 – $170,000
Full‑time | Leadership Role
A well‑established, mission‑driven managed care organization in NewYorkCity is seeking a Director of Integrated Case Management (Medicare) to lead its Medicare Advantage and D‑SNP population. This strategic and operational leadership role is responsible for overseeing integrated care management teams, ensuring regulatory compliance (CMS, DOH, OMH), and driving high‑quality, member‑centered care delivery for complex Medicare populations.
Key Responsibilities
Provide oversight of Medicare Advantage and Dual Eligible (D‑SNP) populations
Ensure adherence to Model of Care and regulatory requirements
Lead and supervise clinical and non‑clinical case management staff
Oversee transitions of care and readmission reduction strategies
Collaborate with UM, Quality, Data Analytics, and Customer Service
Support STAR, HEDIS, and CAHPS improvement initiatives
Drive operational enhancements and performance monitoring
Qualifications
BSN required (Master’s preferred)
Active NYS RN license
10+ years healthcare management experience
5+ years leadership experience (Manager level or above)
5+ years managed care leadership overseeing clinical staff
Strong knowledge of CMS, DOH, OMH regulations
This hybrid leadership role offers competitive compensation, strong benefits, and the opportunity to impact care delivery for complex Medicare populations in NYC.
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Salary: $160,000 – $170,000
Full‑time | Leadership Role
A well‑established, mission‑driven managed care organization in NewYorkCity is seeking a Director of Integrated Case Management (Medicare) to lead its Medicare Advantage and D‑SNP population. This strategic and operational leadership role is responsible for overseeing integrated care management teams, ensuring regulatory compliance (CMS, DOH, OMH), and driving high‑quality, member‑centered care delivery for complex Medicare populations.
Key Responsibilities
Provide oversight of Medicare Advantage and Dual Eligible (D‑SNP) populations
Ensure adherence to Model of Care and regulatory requirements
Lead and supervise clinical and non‑clinical case management staff
Oversee transitions of care and readmission reduction strategies
Collaborate with UM, Quality, Data Analytics, and Customer Service
Support STAR, HEDIS, and CAHPS improvement initiatives
Drive operational enhancements and performance monitoring
Qualifications
BSN required (Master’s preferred)
Active NYS RN license
10+ years healthcare management experience
5+ years leadership experience (Manager level or above)
5+ years managed care leadership overseeing clinical staff
Strong knowledge of CMS, DOH, OMH regulations
This hybrid leadership role offers competitive compensation, strong benefits, and the opportunity to impact care delivery for complex Medicare populations in NYC.
#J-18808-Ljbffr