Director, Medical Case Management – WC Strategy

AmTrust Financial Services, Inc.

Scottsdale (AZ)

On-site

USD 180,000 - 240,000

Full time

14 days+

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Job summary

AmTrust Financial Services, Inc. seeks a Director of Medical Case Management to lead the Western Zone medical case management operations, directing approximately 40 clinicians and four direct-report managers.

The role focuses on proactive, data-driven performance, clinical quality, and improved claim outcomes in a dynamic environment. The position requires a proactive leader with strong clinical judgment and analytical discipline, leveraging dashboards, trends, and performance insights to drive

Qualifications

Active unrestricted RN license in California required; eligibility to obtain/renew a multistate license required.
BSN required; MSN, MBA, MHA, or related advanced degree strongly preferred.
Seven or more years of workers’ compensation medical case management, managed care, utilization management, or clinical operations experience required.
Five or more years of nurse leadership experience required, including experience leading managers, supervisors, or team leads strongly preferred.
Experience in a workers’ compensation insurance carrier, TPA, managed care organization, or multi-jurisdictional claims environment strongly preferred.
Experience using operational data, clinical metrics, dashboards, or performance reporting to lead teams, improve execution, and drive measurable outcomes strongly preferred.
Demonstrated success leading change, developing talent, managing front line leader performance, and building a culture of accountability.
Proven ability to lead effectively in a fast-paced, high-change environment while maintaining focus, urgency, team alignment, and accountability.

Responsibilities

Lead Western Zone workers’ compensation medical case management operations, providing direction, coaching, and accountability for managers and clinical teams.
Drive measurable, data-driven outcomes, including return-to-work results, claim duration, medical spend influence, nurse productivity, quality, staffing, compliance, and operational performance trends.
Use analytics, dashboards, and performance reporting to identify trends, diagnose root causes, prioritize improvement opportunities, and hold leaders accountable for results.
Anticipate emerging issues, risks, and performance gaps before they escal, shifting the organization from reactive issue resolution to proactive performance management.
Translate enterprise medical management strategy into zonal priorities, action plans, SOPs, workflows, and consistent execution expectations.
Empower front line leaders by setting clear standards, strengthening decision-making, developing leadership capability, and holding teams accountable for results.
Lead change management by communicating the “why,” addressing barriers, and supporting successful adoption of new processes, tools, and expectations.
Partner with Claims, Legal, Medical Strategy, Analytics, Compliance, Operations, and other stakeholders to align priorities and improve outcomes.
Ensure effective quality assurance, regulatory compliance, treatment guideline adoption, escalation practices, and claim quality standards.
Build a constructive, outcome-focused culture that promotes ownership, collaboration, innovation, continuous improvement, and strong talent development.
Monitor legal, legislative, and jurisdictional developments that may affect managed care operations and coordinate appropriate business response.