Director, Medical Case Management (Western Zone)

Overview

AmTrust Financial Services is seeking a Director, Medical Case Management for the Western Zone. This senior leader will oversee approximately 40 clinical professionals, including four direct-report managers, and drive proactive, data-driven workers’ compensation medical case management performance, clinical quality, operational consistency, and claim outcomes in a fast-paced, high-change environment.

Responsibilities

Reporting to the Head of Managed Care and Clinical, the Director, Medical Case Management will lead Western Zone workers’ compensation medical case management operations to improve claim outcomes, return-to-work results, medical management impact, quality, compliance, and team performance. This role requires a proactive leader who combines strong clinical judgment with analytical discipline, using data, dashboards, trends, and performance insights to anticipate issues, identify opportunities, drive action, and measure results. The Zonal Director will translate organizational strategy into clear, actionable plans; empower front line leaders and teams; drive adoption of standard practices; foster a high-accountability culture; and communicate the “why” behind decisions to support alignment, engagement, and sustained execution in a rapidly changing environment.

 

• Lead Western Zone workers’ compensation medical case management operations, providing direction, coaching, and accountability for managers and clinical teams.
• Drive measurable, data-driven outcomes, including return-to-work results, claim duration, medical spend influence, nurse productivity, quality, staffing, compliance, and operational performance trends.
• Use analytics, dashboards, and performance reporting to identify trends, diagnose root causes, prioritize improvement opportunities, and hold leaders accountable for results.
• Anticipate emerging issues, risks, and performance gaps before they escalate, shifting the organization from reactive issue resolution to proactive performance management.
• Translate enterprise medical management strategy into zonal priorities, action plans, SOPs, workflows, and consistent execution expectations.
• Empower front line leaders by setting clear standards, strengthening decision-making, developing leadership capability, and holding teams accountable for results.
• Lead change management by communicating the “why,” addressing barriers, and supporting successful adoption of new processes, tools, and expectations.
• Partner with Claims, Legal, Medical Strategy, Analytics, Compliance, Operations, and other stakeholders to align priorities and improve outcomes.
• Ensure effective quality assurance, regulatory compliance, treatment guideline adoption, escalation practices, and claim quality standards.
• Build a constructive, outcome-focused culture that promotes ownership, collaboration, innovation, continuous improvement, and strong talent development.
• Monitor legal, legislative, and jurisdictional developments that may affect managed care operations and coordinate appropriate business response.

Qualifications

• Active unrestricted RN license in California required; eligibility to obtain and/or renew a multistate license required.
• BSN required; MSN, MBA, MHA, or related advanced degree strongly preferred.
• Seven or more years of workers’ compensation medical case management, managed care, utilization management, or clinical operations experience required.
• Five or more years of nurse leadership experience required, including experience leading managers, supervisors, or team leads strongly preferred.
• Experience in a workers’ compensation insurance carrier, TPA, managed care organization, or multi-jurisdictional claims environment strongly preferred.
• Experience using operational data, clinical metrics, dashboards, or performance reporting to lead teams, improve execution, and drive measurable outcomes strongly preferred.
• 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.

Key Skills & Competencies

Clinical, Analytical, Operational, and Leadership Expertise

• 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, da