Director of Case Management Medicare - Hybrid NYC

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 New York City is seeking a Director of Integrated Case Management (Medicare) to lead its Medicare Advantage and D-SNP population.
This is a strategic and operational leadership role 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

• 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.