Director, Case Management & Care Coordination (Equity Eligible)

Antidote Health Group; United States; Remote; USD 135,000 - 150,000; Full time

Benefits offered by this job

Equity

401(k)

Paid vacation and sick time and公司holid

Company holidays

Job summary

Antidote Health in the United States is seeking a Director, Case Management to lead case management, disease management, behavioral health, and transitions-of-care programs in a fast-growing health plan. You will own day-to-day execution, vendor performance, and regulatory readiness.

The role partners with Clinical Operations, Quality, Network, Claims, Product, IT, Compliance, and Vendors to drive improved member outcomes, using data to measure performance and ensure program success.

Qualifications

• RN license is required.
• 7+ years in managed care with at least 3 years in case management leadership.
• Hands-on experience with QNXT and CCA in a health plan or delegated managed care environment.
• Experience managing delegated clinical vendors and enforcing contractual, regulatory, and performance expectations.
• Strong knowledge of NCQA case management and population health standards, regulatory audits, and readiness.
• Advanced reporting and analytical skills, including Excel and vendor data reconciliation.

Responsibilities

• Lead case management, disease management, behavioral health, and transitions-of-care operations, including staffing, productivity, documentation quality, and member engagement.
• Serve as the internal subject-matter expert for QNXT and CCA, including workflow design, configuration support, testing, reporting, issue resolution, and user adoption.
• Hold delegated CM vendors accountable through performance monitoring, audits, scorecards, data validation, corrective action plans, and timely escalation.
• Maintain continuous readiness for NCQA, Marketplace, and state regulatory requirements, including organized evidence, policies, procedures, and audit files.
• Build and improve scalable workflows, controls, and reporting for a rapidly growing health plan; identify gaps and drive solutions without waiting for detailed direction.
• Use utilization, quality, productivity, and financial data to evaluate program performance, identify opportunities, and report results to leadership.
• Develop clear program descriptions, goals, outcome measures, and operating procedures, and ensure assigned deliverables are complete, accurate, and on time.
• Partner with Clinical Operations, Quality, Network, Claims, Product, IT, Compliance, and Vendors to improve care coordination and member outcomes.

Skills

Case management leadership

Managed care

Vendor management

Data analysis

Regulatory compliance

NCQA standards

QNXT/CCA experience

Excel

Education

RN license

CCM certification (preferred)

Tools

QNXT

CCA

Job description

Antidote Health in the United States is seeking a Director, Case Management to lead case management, disease management, behavioral health, and transitions-of-care programs in a fast-growing health plan. You will own day-to-day execution, vendor performance, and regulatory readiness.

The role partners with Clinical Operations, Quality, Network, Claims, Product, IT, Compliance, and Vendors to drive improved member outcomes, using data to measure performance and ensure program success.