Director of Nurse Case Management

Opus Medical

1d•Remote

About The Position

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. The Director partners closely with the SVP of Clinical Operations, clinical teams, and key stakeholders to drive performance, quality outcomes, and departmental growth.

Requirements

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).
Active Registered Nurse (RN) license in good standing required.
Bachelor of Science in Nursing (BSN) required.
A minimum of 5-7 years of clinical nursing experience is required.
A minimum of 3-5 years in case management.

Nice To Haves

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.
Supervisory or leadership experiences is preferred.

Responsibilities

Provides leadership and direction to Case Managers, Supervisors and their designated teams, ensuring day-to-day operations align with company and customer guidelines and expectations.
Oversees the assignment of referrals, ensuring timely and accurate time and notes entry into the case management database, and maintaining adherence to all Opus Medical guidelines and customer requirements.
Drives and manages the overall case management workflow, including reviewing documentation for accuracy, quality, and compliance.
Conducts regular review of departmental reports, invoices, logs, and expense data on a daily, weekly, and monthly basis to monitor performance and identify areas for improvement.
Upholds and enforces compliance with all company policies and legal requirements regarding personal health information (PHI and IIHI).
Ensures quality of service delivery across the department and oversees the resolution of client complaints and escalations.
Manages human resources matters within the department, including performance management, coaching and development of supervisors, and partnering with HR on employee relations issues.
Fosters a culture of accountability, collaboration, and continuous improvement across the case management team.
Provides clinical oversight and direction for case management clinical activities, ensuring nurses are practicing within scope and in accordance with nationally recognized standards of care.
Serves as the clinical authority for the department and may provide guidance and direction to supervisors and case managers on complex referrals.
Participates in marketing and client support activities, attending client meetings, and representing the case management department in organizational and external initiatives.
Mentors and retains talent across the designated team.
Cultivates a high-performance, collaborative, and inclusive team culture.
Sets clear performance expectations and supports team development through coaching and feedback.
Works independently while managing competing priorities across a distributed team.