Job Description

We are currently seeking a Director of Clinical Management & Intake to provide strategic and operational leadership for Workers' Compensation clinical services and intake operations, with direct accountability for developing and executing departmental strategy aligned with growth, service, quality, and financial objectives. This leader oversees teams of Nurse Case Managers, Clinical Support Coordinators, Intake Representatives, and administrative support staff, and holds ownership of departmental budgets, workforce planning, succession planning, and key performance metrics including referral turnaround time, clinical outcomes, network utilization, and client satisfaction. The Director drives operational excellence, champions AI and automation initiatives, participates in business development efforts, and partners with claims leadership, medical providers, clients, and internal stakeholders to ensure high-quality, cost-effective clinical management services and positive outcomes for injured workers.

Candidates must reside in New Jersey or a surrounding state due to regular travel throughout New Jersey.

Key Responsibilities

• Provide strategic leadership and operational oversight for the clinical case management organization, including RN and LPN Nurse Case Managers, Clinical Support Coordinators, and support staff. Develop and execute departmental strategy aligned with growth, service, quality, and financial objectives.
• Lead the intake organization and call center, ensuring accurate, efficient, and timely referral intake, triage, and case assignment processes.
• Ensure contractual service requirements, production targets, quality standards, and departmental objectives are consistently achieved.
• Conduct routine reviews of Nurse Case Manager caseloads and operational performance to ensure quality outcomes, regulatory compliance, and appropriate network utilization.
• Lead, mentor, and develop managers and staff, fostering a culture of accountability, collaboration, engagement, and continuous improvement. Drive workforce planning, organizational design, succession planning, and leadership development initiatives to build a sustainable talent pipeline.
• Serve as a client-facing leader who participates in RFP responses, finalist presentations, client retention efforts, implementation activities, and growth initiatives.
• Support client retention and revenue growth through strong relationship management, service excellence, business development participation, and the development of customized clinical management solutions.
• Build and maintain strong relationships with client service teams, claims professionals, medical providers, employers, and injured workers.
• Oversee case management activities designed to manage medical costs, improve in-network provider utilization, and enhance overall claim outcomes.
• Ensure compliance with all applicable Workers' Compensation regulations, state-specific requirements, and HIPAA privacy standards.
• Establish, monitor, and continuously improve quality assurance programs and service delivery standards.
• Review requests for specialty services and help direct care to appropriate in-network providers and clinical resources.
• Champion the adoption and implementation of technology, automation, AI solutions, and workflow redesign to drive productivity improvements, scalability initiatives, and enhanced service delivery. Lead efforts to identify and deploy innovative tools that improve operational efficiency and reduce manual processes.
• Provide oversight of call center operations and telephony systems, including quality monitoring, performance metrics, and recorded call reviews.
• Assume direct ownership and accountability for departmental budgets, staffing plans, productivity targets, and vendor spend. Develop financial forecasts, monitor variances, and implement corrective actions to achieve financial objectives.
• Own and drive achievement of key performance indicators including referral turnaround time, clinical outcomes, network utilization, and client satisfaction. Analyze operational data and business trends to identify opportunities for process improvement and enhanced performance.
• Collaborate with Claims, Finance, IT, Medical Leadership, and Executive Leadership to achieve organizational objectives and strategic priorities.
• Serve as a liaison between clinical operations and the claims organization to ensure seamless communication, continuity of care, and positive claim outcomes.

Qualifications

• Associate's or Bachelor's degree required; degree in Healthcare Administration, Business Administration, Nursing, or a related field preferred.
• Active Registered Nurse (RN) license preferred; LPN license and equivalent clinical leadership experience may be considered.
• 7-10 years of progressive leadership experience in clinical operations, case management, healthcare services, managed care, or a related field.
• Workers' Compensation, managed care, third-party administrator (TPA), or occupational health experience strongly preferred.
• Demonstrated success leading large-scale operational functions, driving performance, quality, and service excellence, with a track record of leveraging technology, AI, and automation to improve outcomes.
• Proven experience developing and executing strategic initiatives, including P&L ownership or direct budget accountability, while balancing operational, financial, and client objectives.
• Experience managing budgets, operational metrics, workforce planning, organizational design, succession planning, and resource allocation.
• Strong client-facing experience, including RFP participation, executive presentations, finalist meetings, relationship management, business development support, and client retention initiatives.
• Exceptional leadership, communication, problem-solving, and stakeholder management skills, with the ability to influence across all levels of the organization.
• Valid driver's license with the ability to travel regularly to client sites, meetings, and industry events throughout New Jersey and surrounding regions; occasional overnight and evening travel may be required to support business and client needs.

Benefits

We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $133,100 - $150,000 annually, and will be based on a number of additional factors including skills, experience, and education.

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