Director of Care Management

Location: 1701 Barrett Lakes Blvd, St 150, Kennesaw, GA 30144Position Title: Director, Care Management The Director, Care Management is responsible for providing clinical expertise and guidance in support of OneVeracity’s medical management programs to promote the delivery of high quality, cost-effective medical care.This role oversees the Case Management and Precertification departments, ensuring alignment of activities across case management, utilization management, precertification review, and population health programs. The Director ensures compliance with regulatory requirements, supports staff performance and development, and collaborates with internal and external stakeholders to optimize member outcomes and client satisfaction.Key ResponsibilitiesLeadership & Team ManagementSupports the functions of disease management, case management, pre-admission reviews, utilization management, concurrent reviews and retrospective reviews.Provides clinical guidance into the development of the Veracity Care Solution programs.Provide daily supervision, coaching, and professional development for clinical staff.Collaborates with clinical team to achieve optimal patient outcomes.Reviews reporting of clinical activities including protocols and documentation.Oversee staff scheduling, workload allocation, and coverage planning.Conduct regular team meetings and performance evaluations.Staff Development & SupportProvide coaching, education, and training for Case Management Nurses and Precertification Nurses.Ensure team compliance with licensure, certification, and continuing education requirements.Assist in hiring, onboarding, and professional development planning.Operational OversightEnsure timely and accurate processing of case assignments and clinical activities.Support high‑quality patient access to services.Serve as the primary escalation point for complex member or provider issues.Oversee documentation quality and compliance.Collaboration & CommunicationPartner with clinical staff and leadership to support workflows.Ensure appropriate case routing to clinical teams or vendors.Facilitate communication with patients, brokers, employer groups, internal departments, and providers regarding case status, updates and patient needs. Support communication related to member care needs, treatment planning, and provider engagement.Represent the department in cross‑functional meetings.Coordinate with stop‑loss/reinsurance partners when high‑cost cases require reporting or forecasting.Support the escalation and resolution of barriers, psychosocial issues, or gaps in care identified by clinical staff.Quality Improvement & ReportingAssist with departmental reporting and data analysis.Monitor adherence to clinical documentation standards, regulatory requirements, and HIPAA privacy rules.Identify operational gaps and lead process improvement initiatives.Contribute to policy, procedure, and training material development.Other ResponsibilitiesSupport special projects and organizational initiatives.Participate in meetings and maintain confidentiality per HIPAA.Perform other duties as assigned.QualificationsRN Or LCSW with a clear, active and unrestricted license within the United StatesA Bachelors (or higher) degree in a health-related field (Master’s preferred)5+ years of experience in healthcare operations, managed care, benefits administration, or client/member services.3+ years of supervisory or team leadership experience required.Minimum 10 years clinical experience Experience working in a managed care or commercial insurance setting preferredStrong Problem-solving skills are essential including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving medical/clinical issues and problems.Excellent typing, computer and documentation skillsAbility to coordinate and communicate with a multidisciplinary team (internal and external)Ability to multi-task is essential