Job Description

Our client, a leading non-profit medical center in Westchester County, is seeking a Director of Clinical Care Management, RN, to lead a high-impact, multidisciplinary department focused on optimizing patient outcomes, enhancing operational efficiency, and ensuring appropriate financial reimbursement. This role carries 24/7 accountability and oversight for Access, Utilization Review, Denials and Appeals, Care Coordination, Discharge Planning, Clinical Social Work, Recovery and Disease Management, and Contracting. The Director will serve as a strategic resource to the Executive Team, partnering with internal departments, external payers, system partners, and community organizations to lead innovative care management strategies that are patient-centered, financially sustainable, and compliant with all regulatory requirements. This is a pivotal leadership role with a high-performing, mission-driven medical center known for its clinical excellence and commitment to the community. If you’re a strategic thinker who thrives in a collaborative environment and wants to make a measurable impact on patient care, this opportunity offers both purpose and growth.

Key Responsibilities

• Provide strategic and operational leadership for all Care Management services.
• Manage daily operations, staffing, budgeting, and performance metrics for all areas under Clinical Care Management.
• Lead, guide, and mentor Nurse Care Managers and Social Work Managers, ensuring alignment with departmental and organizational goals.
• Develop and monitor department goals, policies, budgets, and quality metrics in line with the organization’s mission and strategic plan.
• Ensure compliance with regulatory and accreditation standards across all care management functions.
• Oversee the Care Management Dashboard, reporting, and key performance indicators (KPIs) including readmissions, denials, length of stay, and discharge planning effectiveness.
• Facilitate interdisciplinary collaboration across the organization to support seamless transitions of care and optimal patient outcomes.
• Participate in executive committees, performance improvement initiatives, and hospital-wide strategy development.
• Maintain professional relationships with providers, payers, community partners, and vendors.
• Lead the Utilization Review Committee and other assigned task forces.
• Serve as a subject matter expert in managed care principles, clinical workflows, and value-based care strategies.
  
  

Qualifications

• RN with BSN or MSN required; Master's in Clinical or Healthcare Administration preferred.
• CMAC or CCM certification preferred.
• Minimum 1 year of acute care hospital experience.
• At least 1 year in non-hospital-based healthcare settings (home care, insurance, outpatient, etc.).
• Prior experience managing a team or leading complex healthcare projects required.
• Demonstrated leadership in human resource management, strategic planning, and change management.
• Strong knowledge of:
• DRGs, Medicare regulations, and medical necessity criteria
• Patient rights, HIPAA, and regulatory compliance
• Clinical system assessments and risk stratification strategies
• Advanced capabilities in technical writing and data-driven program evaluation.
• Strong interpersonal and communication skills with a collaborative and proactive leadership style.
• High level of critical thinking and decision-making ability.
• Proficiency in relevant healthcare IT systems and data analytics tools.
  
  

Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.