Case Management Medical Director

NTX Talent is proud to partner with a leading healthcare organization to recruit top talent for their expanding team. Our client is an industry leader in serving eligible populations through innovative operating and clinical models.

We're seeking a dynamic Case Management Medical Director to join this remote opportunity. This work-from-home position supports regions in the Eastern Time Zone (2 regions) and Central Time Zone (1 region). Preference for candidates who can flexibly work in either time zone.

In this role, you'll collaborate with members, providers, and community organizations to deliver quality solutions addressing the full spectrum of health care and social determinant needs. You'll play a key part in executing and deploying Models of Care across assigned markets, facilitating impactful care coordination focused on transitions, communication, and ensuring program effectiveness, member safety, and quality care delivery.

Join a forward-thinking team as they grow and expand into new markets nationwide!

Primary Duties and Responsibilities:

Provide clinical oversight of case management teams and Interdisciplinary Care Team (ICT) processes, including developing members Individual Care Plans (ICP) and supporting staff in addressing physical, behavioral, and socioeconomic needs.

Offer clinical guidance for Long Stay, Palliative Care, Transition of Care, and/or other clinical initiatives and rounds.

Contribute to strategies, tactics, and programs for case management and community engagement with members, partners, and providers to develop tailored local approaches.

Leverage clinical platforms for case review.

Provide clinical guidance and leadership to case management and clinical team colleagues (including social work and pharmacy).

Collaborate with learning and performance teams to develop clinical training for case management staff, such as creating 5 "Clinical Pearls" presentations annually.

Conduct provider outreach to collaborate and resolve member needs.

Offer guidance and oversight to Nurse Practitioners on clinical rounds, including case preparation, selection, and outreach to providers and members as needed.

Perform clinical review and adjudication of appeals cases when required.

Professional Development: Oversee and manage one regional case management initiative in collaboration with senior leadership.

Ensure timely execution of all deliverables in line with due dates and regulatory requirements.

Travel to provider and member meetings as indicated (approximately 10%).

Required Qualifications:

Active and current medical license (MD or DO) without encumbrances.

Board Certification, including Maintenance of Certification, in Family Practice, Internal Medicine, or Geriatrics.

Post-graduate experience with at least 5 years of direct patient care.

Flexibility with work schedule to meet business needs.

3-5 years of Managed Care experience; Medicare highly preferred.

3-5 years of Case Management experience.

Ability to work effectively in a highly matrixed organization/environment.

Strong engagement skills at all levels, including physicians, vendors, community partners, administrative leaders, clinical leaders, and staff.

Agility to manage multiple priorities and adapt to change with enthusiasm.

Ability to work virtually with occasional travel for in-person member and provider meetings (10%).