| Location | New York, NY |
Title: RN – Care Manager – Managed Long-Term Care (MLTC/MAP)
Location: New York, NY 10004
Duration: 8 weeks (December 7, 2026 – January 30, 2027)
Shift: Day Shift, 9:00 AM – 5:00 PM
Schedule: Monday–Friday, 5 days/week, 7 hours/day, 35 hours/week. Full-time. Hybrid work arrangement. On-call rotation required.
Pay: $60/hr.
Note: Non-patient-facing position.
Active New York State Registered Nurse (RN) license.
Bachelor's degree required; BSN preferred.
Minimum 5 years of clinical experience as a Registered Nurse.
2–3 years of clinical experience in a Certified Home Health Agency (CHHA), Lombardi program, and/or MLTC or MAP program.
Experience in Utilization Management, Case Management, Care Coordination, Utilization Review, and Discharge Planning.
Bilingual English/Spanish proficiency required (speaking, reading, and writing).
PRI and Screen certification required within 3 months of employment.
Computer literacy required.
Leadership experience preferred.
Master's degree preferred.
Certification in Case Management preferred.
Review and evaluate member assessments and Uniform Assessment System (UAS) information for MLTC and MAP programs.
Develop and communicate individualized care plans in partnership with members, families, caregivers, primary care physicians, and other providers.
Identify member risk factors, strengths, challenges, service needs, and appropriate risk categories.
Coordinate with primary care physicians to review assessment findings and address clinical concerns.
Develop formal care plans covering required services, including the member's disaster plan.
Monitor members at least monthly, primarily by telephone and face-to-face when necessary.
Identify clinical issues requiring immediate assessment or treatment to reduce unnecessary hospitalizations, emergency department visits, and nursing home admissions.
Identify opportunities to improve preventive and chronic disease care.
Review and approve requests for additional services based on assessments and evidence-based standards; refer denials, reductions, or limitations to the Medical Director.
Coordinate services within and outside provider networks, including discharge planning from acute and alternate care settings.
Coordinate care across the continuum and collaborate with Utilization Management on concurrent and retrospective reviews.
Follow up with assigned nurses for clinical updates to care plans.
Document coordination notes and routine member contacts within two business days, according to assigned risk levels.
Participate in team care planning meetings and address complaints that can be resolved within one day.
Support Customer Service and Utilization Management with records and materials needed for member grievances.
Communicate with members regarding delinquent spend-down payments.
Identify members appropriate for specialty programs.
Ensure MLTC/MAP management activities comply with regulatory requirements.
Provide information requested by Quality Management for review by Quality committees.
Participate in the department's rotating on-call schedule.
Perform other duties assigned by department leadership.