Director of Integrated Case Management / RN / Hybrid

Director of Integrated Case Management (ICM) RN | Hybrid Schedule
Up to $170,000 + Excellent Benefits (including a pension plan!)
Full-Time | Permanent | MondayFriday | 2 Days in NYC Office, 3 Days Remote
About the Organization
For more than 30 years, this mission-driven health plan has been committed to delivering high-quality care to New Yorkers. Serving the Bronx, Brooklyn, Manhattan, Queens, and Staten Island, the organization offers a range of comprehensive health coverage options. They take pride in building strong relationships with members, providers, and the communities they serve.
About the Role
We are seeking a dynamic Director of Integrated Case Management (ICM) to lead clinical and operational functions for the Medicare Advantage and Integrated Benefits for Dually Eligible (IB-Dual) population, also known as the Medicare Dual Eligible Special Needs Plan (D-SNP). Reporting to the Senior Director of Integrated Care Management, this role ensures compliance with CMS requirements, oversees daily operations, and supports staff in delivering high-quality, person-centered care that addresses members' medical, behavioral, and social needs.
Key Responsibilities

• Partner in developing and executing the strategic vision for the ICM department.
• Lead, supervise, and mentor a multidisciplinary team delivering care management for the Medicare line of business.
• Ensure adherence to CMS regulations, the Medicare Model of Care, and internal care management protocols (screening, assessment, implementation, evaluation).
• Oversee transitions of care, developing strategies to reduce hospital readmissions and support members in community-based settings.
• Lead implementation of quality improvement initiatives in collaboration with Quality Management, UM, and Data Analytics teams.
• Collaborate cross-functionally with internal departments and external partners on key projects and initiatives.
• Provide clinical input on Quality-of-Care concerns and support strategies to improve HEDIS, STAR ratings, and CAHPS scores.
• Ensure new hires receive effective onboarding and provide ongoing staff development and performance coaching.
• Monitor departmental performance, analyze trends, and implement data-driven process improvements.
• Represent the ICM team in organizational meetings and workgroups.
• Provide regular updates to the Senior Director on departmental operations and performance.

Qualifications
Education & Experience

• Bachelor of Science in Nursing (BSN) required; Masters Degree in Nursing preferred.
• Minimum 10 years of healthcare management experience, including at least 5 years in a leadership role (Manager level or above).
• At least 5 years of experience managing both clinical and non-clinical staff in a managed care setting.
• Strong knowledge of CMS, OMH, and DOH regulations, with experience in care coordination models in managed care environments.

Licensure

• Active and unencumbered RN license in the state of New York is required.

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