Director, Medical Case Management (Western Zone)
On-siteScottsdale, Arizona, United States or South, Kentucky, United States
Scottsdale, Arizona, United States or South, Kentucky, United StatesOn-siteFull TimeSenior LevelLarge
Full TimeSenior LevelLarge
Job Summary
Lead Western Zone workers' compensation medical case management operations by providing direction, coaching, and accountability for managers and clinical teams. Drive measurable outcomes including return-to-work results, claim duration, medical spend influence, and operational performance trends using analytics, dashboards, and performance reporting. Translate enterprise strategy into zonal priorities, action plans, SOPs, and workflows while ensuring quality assurance, regulatory compliance, and treatment guideline adoption. Anticipate emerging issues, risks, and performance gaps to shift the organization from reactive resolution to proactive management. Empower front-line leaders by setting clear standards, developing capability, and fostering a high-accountability culture. Partner with Claims, Legal, Medical Strategy, Analytics, Compliance, and Operations stakeholders to align priorities and improve outcomes. Monitor legal, legislative, and jurisdictional developments to coordinate appropriate business responses.
Required Qualifications
- Active unrestricted RN license in California
- Eligibility to obtain and/or renew a multistate license
- BSN
- Seven or more years of workers' compensation medical case management, managed care, utilization management, or clinical operations experience
- Five or more years of nurse leadership experience
- Experience leading managers, supervisors, or team leads
- Experience in a workers' compensation insurance carrier, TPA, managed care organization, or multi-jurisdictional claims environment
- Experience using operational data, clinical metrics, dashboards, or performance reporting to lead teams, improve execution, and drive measurable outcomes
- 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
- Strong knowledge of workers' compensation laws, regulations, case management practices, managed care requirements, treatment guidelines, quality assurance, and medical management practices
- Proven ability to lead leaders, manage geographically dispersed clinical teams, and create consistent expectations across a complex organization
- Strong analytical capability with the ability to use data, metrics, dashboards, and performance trends to create action plans that improve claim, clinical, operational, and team outcomes
- Ability to challenge assumptions, ask insightful questions, connect clinical activity to business results, and convert analysis into practical execution
- Strong change leadership skills, including the ability to communicate the 'why,' influence adoption, and sustain compliance
- Proactive, forward-looking leadership style with the ability to anticipate needs, make timely decisions, and quickly adjust priorities as business conditions change
- Excellent stakeholder management, communication, presentation, collaboration, negotiation, and analytical skills
- Experience developing and implementing SOPs, policies, procedures, program improvements, and performance plans
- Ability to foster a culture of ownership, accountability, innovation, teamwork, and continuous improvement
- Demonstrates a strong commitment to achieving ambitious goals and delivering exceptional results
- Proactively identifies opportunities, addresses challenges, and drives initiatives forward with minimal direction
- Brings a high level of energy, determination, and accountability in a dynamic, fast-paced environment
- Continuously seeks opportunities to enhance processes, improve performance, and drive measurable outcomes
- Builds strong partnerships by valuing collaboration and actively seeking diverse perspectives
- Exhibits self-awareness and embraces feedback as a tool for continuous growth and development
- Recognizes team contributions, shares credit for successes, and supports others in achieving collective goals
- Approaches challenges with curiosity, openness, and respect, fostering an inclusive and positive work environment
- Anticipates future business needs and develops forward-looking solutions that align with organizational priorities
- Connects daily responsibilities and decisions to broader business objectives and long-term strategy
- Leverages data, market intelligence, and business insights to make informed, impactful decisions
- Balances immediate priorities with long-term opportunities to drive sustainable business success
Desired Qualifications
- MSN, MBA, MHA, or related advanced degree
- Experience leading managers, supervisors, or team leads
- Experience in a workers' compensation insurance carrier, TPA, managed care organization, or multi-jurisdictional claims environment
- Experience using operational data, clinical metrics, dashboards, or performance reporting to lead teams, improve execution, and drive measurable outcomes
- 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
- Strong knowledge of workers' compensation laws, regulations, case management practices, managed care requirements, treatment guidelines, quality assurance, and medical management practices
- Proven ability to lead leaders, manage geographically dispersed clinical teams, and create consistent expectations across a complex organization
- Strong analytical capability with the ability to use data, metrics, dashboards, and performance trends to create action plans that improve claim, clinical, operational, and team outcomes
- Ability to challenge assumptions, ask insightful questions, connect clinical activity to business results, and convert analysis into practical execution
- Strong change leadership skills, including the ability to communicate the 'why,' influence adoption, and sustain compliance
- Proactive, forward-looking leadership style with the ability to anticipate needs, make timely decisions, and quickly adjust priorities as business conditions change
- Excellent stakeholder management, communication, presentation, collaboration, negotiation, and analytical skills
- Experience developing and implementing SOPs, policies, procedures, program improvements, and performance plans
- Ability to foster a culture of ownership, accountability, innovation, teamwork, and continuous improvement
- Demonstrates a strong commitment to achieving ambitious goals and delivering exceptional results
- Proactively identifies opportunities, addresses challenges, and drives initiatives forward with minimal direction
- Brings a high level of energy, determination, and accountability in a dynamic, fast-paced environment
- Continuously seeks opportunities to enhance processes, improve performance, and drive measurable outcomes
- Builds strong partnerships by valuing collaboration and actively seeking diverse perspectives
- Exhibits self-awareness and embraces feedback as a tool for continuous growth and development
- Recognizes team contributions, shares credit for successes, and supports others in achieving collective goals
- Approaches challenges with curiosity, openness, and respect, fostering an inclusive and positive work environment
- Anticipates future business needs and develops forward-looking solutions that align with organizational priorities
- Connects daily responsibilities and decisions to broader business objectives and long-term strategy
- Leverages data, market intelligence, and business insights to make informed, impactful decisions
- Balances immediate priorities with long-term opportunities to drive sustainable business success
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