Director of Case Management

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 is a tech-drivenhealth insurance company on a mission to make healthcareeasy, accessible, and more affordable.We’rerethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences,we’rebuilding a simpler, more connected way for people to get care.

Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help peopleactually usetheir benefits.

We offerAffordableCare Act (ACA) health plans in Arizona and Ohio, andwe’regrowing quickly.We’rebuilding a company focused on solving real problems—withrealimpact on people’s lives.

Position Overview

The Director, Case Management leads Antidote Health’s case management, disease management, behavioral health, and transitions-of-care programs. This hands-on leader owns day-to-day execution, delegated vendor performance, QNXT/CCA workflows, regulatory compliance, reporting, and measurable member outcomes in a fast-paced, rapidly growing environment.

Key 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.

Qualifications

Required:

• Active, unrestricted RN license.
• 7+ years of managed care experience, including at least 3 years in case management leadership.
• Deep, hands-on experience with QNXT and CCA in a health plan or delegated managed care environment.
• Demonstrated 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 continuous readiness.
• Advanced reporting and analytical skills, including Excel and the ability to validate and reconcile vendor data.
• Proven ability to work independently, manage competing priorities, and deliver in a fast-paced, high-growth environment.

Preferred:

• CCM certification, or comparable advanced clinical or managed care credential.
• Experience implementing or transitioning care management platforms, programs, or delegated functions.

Core Competencies

• Operational ownership and follow-through
• Vendor accountability and performance management
• Adaptability, urgency, and sound judgment
• Clear communication and cross-functional leadership

Compensation and Benefits

• Base salary range: $135,000 - $150,000 (commensurate with experience and location)
• Eligibility for Equity
• 401(k)
• Paid vacation and sick time and company holidays

Company Standards and Expectations

• Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law
• Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct
• Responsibilities may evolve based on business needs, and flexibility is expected as the company scales
• Compliance with all applicable federal, state, and local laws and regulations is required

Equal Opportunity Statement

Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.