Care Manager - RN

Registered Nurse Care Manager

We are seeking an experienced Registered Nurse Care Manager to support care coordination for members enrolled in managed long-term care programs. This role is ideal for an RN with strong experience in care management, utilization review, discharge planning, and community-based healthcare.

Key Responsibilities

• Review member assessments and UAS information for MLTC and MAP programs.
• Develop comprehensive, individualized care plans based on member needs and identified risks.
• Collaborate with primary care physicians, nurses, caregivers, and other healthcare providers.
• Monitor member conditions and identify issues requiring timely clinical intervention.
• Coordinate services across the continuum of care, including transitions and discharge planning.
• Help reduce unnecessary hospitalizations, emergency department visits, and nursing home admissions.
• Partner with Utilization Management on concurrent and retrospective reviews.
• Ensure members receive appropriate preventive and chronic disease care.
• Maintain timely and accurate care management documentation.
• Participate in interdisciplinary care planning and a rotating on-call schedule.
• Ensure care management activities meet applicable MLTC/MAP regulatory requirements.

Key Qualifications

• Active New York State Registered Nurse license required.
• Bachelor's degree required; BSN preferred.
• Minimum 5 years of clinical RN experience.
• 2 to 3 years of experience in CHHA, Lombardi, MLTC and/or MAP programs.
• Experience with care coordination, utilization review, and discharge planning.
• PRI and Screen certification required within three months of employment.
• Strong computer and clinical documentation skills.
• Leadership experience preferred.
• Master's degree, Case Management certification, and bilingual Spanish skills are preferred.