Vice President, Nurse Case Management and Nurse Triage

Gallagher•Rolling Meadows, IL

About The Position

The Vice President of Nurse Case Management and Nurse Triage provides strategic and operational leadership for the organization’s Nurse Case Management (NCM) and Nurse Triage services. This role develops and executes the strategy, drives consistent clinical and operational practices, optimizes outcomes for injured workers and clients, and ensures services meet regulatory, contractual, and organizational requirements. The Vice President leads the continued evolution of the NCM and Nurse Triage operating model, including nurse triage, field and telephonic case management, clinical quality, workforce strategy, technology enablement, vendor management, performance measurement, and integration with the broader Managed Care organization. The role also leads and develops NCM and Nurse Triage teams, oversees financial and operational performance, supports strategic clients, and modernizes services through workflow redesign, technology, analytics, automation, and continuous improvement.

Requirements

Minimum of 8 years of experience in case management or a related field.
Minimum of 5 years of supervisory experience.
Bachelor’s degree required.
Ability to travel approximately 50% of the time and work non-traditional hours.

Nice To Haves

Certification in CCM, CDMS, CRRN, COHN, CRS, or similar.
Significant leadership experience within Nurse Case Management and Nurse Triage, including experience in workers’ compensation, managed care, occupational health, disability management, or a related clinical environment.
Demonstrated experience leading large, geographically dispersed clinical operations.
Strong understanding of workers’ compensation clinical management, return-to-work principles, and Nurse Triage assessment, protocols, appropriate care recommendations, and escalation practices.
Experience managing financial and operational performance.
Demonstrated ability to lead organizational change and large-scale process improvement.
Strong executive communication, client presentation, and relationship-management skills.
Ability to operate effectively across clinical, operational, financial, technology, regulatory, and commercial functions.

Responsibilities

Develop and execute the national Nurse Case Management and Nurse Triage strategy in alignment with Managed Care and organizational objectives.
Establish the future-state operating model for nurse triage, field, telephonic, and specialty case management services.
Identify opportunities to expand capabilities, improve clinical outcomes and client experience, and drive profitable growth.
Partner with Claims, Sales, Account Management, Legal, Compliance, Finance, IT, and other Managed Care functions on strategic priorities.
Represent Nurse Case Management and Nurse Triage in executive, client, and cross-functional discussions.
Oversee NCM operations and Nurse Triage services, including service delivery, clinical quality, staffing, coverage, protocols, response times, documentation, escalation, and coordination with Claims and NCM.
Establish standardized workflows, clinical protocols, documentation expectations, escalation processes, and performance standards.
Promote coordination among injured workers, employers, adjusters, treating providers, and other stakeholders, including effective handoffs from Nurse Triage to Claims and NCM.
Drive return-to-work strategies and appropriate medical management through NCM, and timely assessment and guidance to the appropriate level of care through Nurse Triage.
Monitor NCM caseloads and capacity, Nurse Triage call volumes and response times, staffing, service levels, and performance trends.
Establish clinical governance and quality assurance frameworks and ensure compliance with state requirements, professional nursing standards, client requirements, and organizational policies.
Partner with Legal and Compliance to identify and mitigate clinical, regulatory, and operational risk.
Oversee quality audits, documentation standards, Nurse Triage protocol adherence and escalation reviews, corrective actions, and continuous improvement.
Maintain safeguards around clinical decision-making and scope of practice.
Own operational performance and contribute to revenue, expense, profitability, and budget objectives.
Develop staffing and capacity models and monitor key performance indicators to balance service quality, growth, productivity, coverage, and financial performance.
Support pricing models, business cases, client solutions, and new service offerings; partner with Finance and leadership on forecasts and performance evaluation.
Lead modernization through workflow redesign, automation, data, analytics, and technology.
Provide business leadership for platform development and implementation, including triage call management, clinical decision support, documentation, and handoffs.
Champion adoption of new tools and processes and establish dashboards and performance measures for data-driven decisions.
Identify appropriate opportunities for AI and automation while maintaining clinical oversight and controls.
Lead and develop NCM and Nurse Triage leaders responsible for field case management, telephonic case management, and nurse triage operations.
Establish accountability, leadership expectations, succession planning, and professional development.
Develop workforce strategies addressing recruitment, retention, geographic coverage, licensing, span of control, specialized clinical capabilities, and triage staffing and coverage.
Build a culture of accountability, collaboration, continuous improvement, and clinical excellence; develop future leaders and organizational capabilities.
Serve as an executive clinical and operational resource for strategic clients and prospects.
Participate in client presentations, stewardship meetings, RFPs, implementations, and solution-development activities.
Translate client needs and market trends into service enhancements and new solutions.
Partner with Sales and Account Management to communicate the value and measurable impact of NCM and Nurse Triage.
Support expansion into new jurisdictions, client segments, and delivery models.