Head of Case Management & Care Coordination

Antidote Health Group; Kentucky; On-site; USD 135,000 - 150,000; Full time

Benefits offered by this job

Eligibility for Equity

401(k)

Paid vacation and sick time and public

Job summary

Antidote Health in the United States is seeking a Director of Case Management to oversee case management, disease management, behavioral health, and transitions-of-care programs. You will own day-to-day execution, vendor performance, QNXT/CCA workflows, regulatory compliance, and reporting to drive measurable member outcomes.

You will build scalable workflows, monitor performance with dashboards, and collaborate with Clinical Operations, Quality, IT, and Vendors to improve care coordination

Qualifications

• Active, unrestricted RN license.
• 7+ years of managed care experience, including at least 3 years in case management leadership.
• 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.

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

Vendor management

Data analysis

Cross-functional leadership

Regulatory compliance

Project management

Education

RN license (active)

Tools

QNXT

CCA

Job description

Antidote Health in the United States is seeking a Director of Case Management to oversee case management, disease management, behavioral health, and transitions-of-care programs. You will own day-to-day execution, vendor performance, QNXT/CCA workflows, regulatory compliance, and reporting to drive measurable member outcomes.

You will build scalable workflows, monitor performance with dashboards, and collaborate with Clinical Operations, Quality, IT, and Vendors to improve care coordination