Our client, a leading non-profit medical center in Westchester County, is seeking a Director of Clinical Care Management, RN or LCSW, 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 youre 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 ResponsibilitiesProvide 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 organizations 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.QualificationsEducation & Credentials (Candidates must qualify under one of the following pathways):If RN:RN with BSN or MSN required; Master's in Clinical or Healthcare Administration preferred.CMAC or CCM certification preferred.If Social Worker:Masters in Social Work (MSW); LMSW or LCSW required.CMAC or CCM certification preferred.ExperienceMinimum 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.Skills and CompetenciesDemonstrated leadership in human resource management, strategic planning, and change management.Strong knowledge of:DRGs, Medicare regulations, and medical necessity criteriaPatient rights, HIPAA, and regulatory complianceClinical system assessments and risk stratification strategiesAdvanced 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. #LI-VS1
