The Vice President of Nurse Case Management and Nurse Triage provides strategic and operational leadership for the organization’s Nurse Case Management (NCM) and Nurse Triage services. This role is accountable for developing and executing the NCM and Nurse Triage strategy, driving consistent clinical and operational practices, optimizing outcomes for injured workers and clients, and ensuring services are delivered in accordance with regulatory, contractual, and organizational requirements.

The Vice President leads the continued evolution of the NCM and Nurse Triage operating model, including nurse triage, field and telephonic case management, clinical quality, workforce strategy, technology enablement, vendor management, performance measurement, and integration with the broader Managed Care organization.

Strategic Leadership

• Develop and execute the national Nurse Case Management and Nurse Triage strategy in alignment with overall Managed Care and organizational objectives.

• Establish the future-state operating model for NCM and Nurse Triage, including nurse triage, field, telephonic, and specialty case management services.

• Identify opportunities to expand NCM and Nurse Triage capabilities, improve clinical outcomes, enhance the client experience, and drive profitable growth.

• Partner with Claims, Sales, Account Management, Legal, Compliance, Finance, IT, and other Managed Care functions to advance strategic priorities.

• Represent Nurse Case Management and Nurse Triage in executive, client, and cross-functional discussions.

Clinical & Operational Oversight

• Provide executive oversight of NCM operations, ensuring consistent service delivery, clinical quality, productivity, and appropriate utilization of resources.

• Provide executive oversight and operational leadership for Nurse Triage services, including staffing, coverage, clinical protocols, timely response, documentation, escalation, and coordination with Claims and Nurse Case Management.

• Establish standardized workflows, clinical protocols, documentation expectations, escalation processes, and performance standards for NCM and Nurse Triage.

• Promote effective coordination among injured workers, employers, adjusters, treating providers, and other stakeholders, including seamless handoffs from Nurse Triage to Claims and Nurse Case Management.

• Drive effective return-to-work strategies and appropriate medical management through NCM, and timely assessment and guidance to the appropriate level of care through Nurse Triage, while maintaining focus on the needs of the injured worker.

• Monitor NCM caseloads and capacity, Nurse Triage call volumes and response times, staffing, service levels, and emerging performance trends across both services.

Quality, Compliance & Risk

• Establish a strong clinical governance and quality assurance framework for Nurse Case Management and Nurse Triage.

• Ensure NCM and Nurse Triage operations are aligned with applicable state-specific requirements, professional nursing standards, client requirements, and organizational policies.

• Partner with Legal and Compliance to identify and mitigate clinical, regulatory, and operational risk.

• Oversee quality audits, documentation standards, Nurse Triage protocol adherence and escalation reviews, corrective-action initiatives, and continuous-improvement activities across NCM and Nurse Triage.

• Maintain appropriate safeguards around clinical decision-making and scope of practice.

Financial & Business Performance

• Own NCM and Nurse Triage operational performance and contribute to revenue, expense, profitability, and budget objectives.

• Develop staffing and capacity models for NCM and Nurse Triage that balance service quality, growth, productivity, coverage, and financial performance.

• Monitor key performance indicators and identify opportunities to increase efficiency without compromising clinical quality.

• Support development of pricing models, business cases, client solutions, and new NCM and Nurse Triage offerings.
• Partner with Finance and leadership to establish forecasts and evaluate performance against plan.

Technology & Transformation

• Lead modernization of Nurse Case Management and Nurse Triage through workflow redesign, automation, data, analytics, and technology.

• Provide business leadership for NCM and Nurse Triage platform development and implementation, including triage call management, clinical decision support, documentation, and handoffs, ensuring technology supports clinical workflows rather than simply digitizing legacy processes.

• Champion adoption of new tools and processes across the organization.

• Establish meaningful dashboards and performance measures to improve transparency and facilitate data-driven decisions.

• Identify appropriate opportunities for AI and automation across NCM and Nurse Triage while maintaining clinical oversight and appropriate controls.

Talent & Organizational Leadership

• Lead and develop NCM and Nurse Triage leaders responsible for field case management, telephonic case management, and nurse triage operations.

• Establish clear accountability, leadership expectations, succession planning, and professional development.

• Develop workforce strategies for NCM and Nurse Triage addressing recruitment, retention, geographic coverage, licensing, span of control, specialized clinical capabilities, and triage staffing and coverage.

• Build a culture of accountability, collaboration, continuous improvement, and clinical excellence.

• Develop future leaders and strengthen organizational capabilities as the business grows.

Client & Market Leadership

• Serve as an executive clinical and operational resource for strategic clients and prospects across NCM and Nurse Triage services.

• Participate in client presentations, stewardship meetings, RFPs, implementations, and solution-development activities.

• Translate client needs and market trends into service enhancements and new solutions.

• Partner with Sales and Account Management to articulate the value and measurable impact of NCM and Nurse Triage.

• Support growth of NCM and Nurse Triage into new jurisdictions, client segments, and delivery models.

Required:

• Minimum of 8 years of experience in case management or related field.
• Minimum of 5 years supervisory experience.
• Bachelors degree required.
• Must be able to travel approximately 50% of the time and non traditional work hours.

Preferred:

• Prefer certification in CCM, CDMS, CRRN, COHN, or CRS, etc.
• Significant leadership experience within Nurse Case Management and Nurse Triage, with experience in workers’ compensation, managed care, occupational health, disability management, or a related clinical environment.
• Demonstrated experience leading large, geographically dispersed clinical operations.
• Strong understanding of workers’ compensation clinical management, return-to-work principles, and Nurse Triage assessment, protocols, appropriate care recommendations, and escalation practices.
• Experience managing financial and operational performance.
• Demonstrated ability to lead organizational change and large-scale process improvement.
• Strong executive communication, client presentation, and relationship-management skills.
• Ability to operate effectively across clinical, operational, financial, technology, regulatory, and commercial functions.

#LI-HL1

At Gallagher, we believe supporting our colleagues goes far beyond the role itself. For more information, visit our Benefits page.

• Competitive compensation
• Comprehensive benefits programs designed to support your well-being
• Career development opportunities and ongoing learning
• A collaborative, people-first culture with accessible leadership
• The opportunity to do meaningful work with global reach and local impact

At Gallagher, we are dedicated to building an inclusive and authentic workplace. If your past experience doesn’t align perfectly, we encourage you to join our Talent Community to stay connected to additional career opportunities. At times, we will consider transferable skills from previous roles.

Gallagher is an affirmative action/equal opportunity employer (Minorities/Females/Veterans/Disabled)