Head of Case Management & Care Coordination

Antidote Health; New York (NY); On-site; USD 135,000 - 150,000; Full time

Benefits offered by this job

Equity eligibility

401(k)

Paid vacation and sick time and agency

Job summary

Antidote Health in New York seeks a Director of Case Management to lead case management, disease management, behavioral health, and transitions-of-care programs. This hands-on leader will own day-to-day execution, vendor performance, and regulatory readiness in a fast-growing health plan.

You will design scalable workflows, use data to drive improvements, and collaborate with Clinical Operations, Quality, Network, Claims, IT, and Compliance to ensure measurable member outcomes and NCQA-aligned

Qualifications

• Active, unrestricted RN license.
• 7+ years of managed care experience, including at least 3 years in case management leadership.
• Deep experience with QNXT and CCA in a health plan or delegated managed care environment.
• Demonstrated experience managing delegated clinical vendors and enforcing contractual and regulatory expectations.
• Strong knowledge of NCQA case management and population health standards and audits.
• Advanced reporting and analytical skills, including Excel, with vendor data validation.
• Ability to work independently in a fast-paced, high-growth environment.

Responsibilities

• Lead case management, disease management, behavioral health, and transitions-of-care operations, including staffing and productivity.
• Serve as internal subject-matter expert for QNXT and CCA, including workflow design, configuration, testing, reporting, and user adoption.
• Monitor delegated CM vendors with audits, scorecards, and corrective actions.
• Ensure NCQA, Marketplace, and state regulatory readiness with organized evidence and procedures.
• Build scalable workflows, controls, and reporting for a rapidly growing health plan.
• Use utilization, quality, and financial data to evaluate performance and report results to leadership.
• Develop clear program descriptions, goals, and operating procedures.

Skills

Vendor management

Communication

Cross-functional leadership

Analytical skills

Education

RN license

CCM certification preferred

Tools

QNXT

CCA

Excel

Job description

Antidote Health in New York seeks a Director of Case Management to lead case management, disease management, behavioral health, and transitions-of-care programs. This hands-on leader will own day-to-day execution, vendor performance, and regulatory readiness in a fast-growing health plan.

You will design scalable workflows, use data to drive improvements, and collaborate with Clinical Operations, Quality, Network, Claims, IT, and Compliance to ensure measurable member outcomes and NCQA-aligned