The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership with the member, their family or significant other, primary caregiver, the primary and/or the attending physicians, and various providers. Using the assessments and interview completed by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member as they strive to keep them safe and well in their community setting.

Title - RN Care Manager
Shift - 9 AM - 5 PM (Hybrid ) | 35 hours per week
Location, New York, NY 10004
Duration - 10/12/2026 - 12/05/2026
Pay range - $60/hr - $65/hr.

Summary
Client committed to empowering New Yorkers by uniting communities through care. We believe that health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership with the member, their family or significant other, primary caregiver, the primary and/or the attending physicians, and various providers.
Using the assessments and interview completed by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member as they strive to keep them safe and well in their community setting.

Product of Role & Responsibilities

Assessment & Care Planning

• Review and evaluate the assessment and UAS information for members in the MLTC and MAP lines of business.
• Develop a working relationship with the PCP to be able to contact and discuss the care of the member with them.
• Review assessment findings with the PCP to identify any concerns that have not been identified by the clinical team.
• Identify the risk factors and assign the risk category to the member.
• As part of the Care Management team, develop a formal care plan for all services needed for the member, including the member's disaster plan.

Member Monitoring & Clinical Coordination

• Monitor the condition of all members at least monthly, typically by telephone but via face-to-face when necessary.
• Identify clinical issues that require immediate clinical assessment and/or treatment to reduce the risk of unnecessary hospitalizations, Emergency Department (ED) visits, or nursing home admissions.
• Identify opportunities to improve the quality of care by ensuring members receive needed preventative and chronic disease care.
• Assist members with the coordination of services both within and outside networks as appropriate, including facilitating discharge from acute settings and alternate settings.
• Provide Care Coordination throughout the continuum of care.
• Optimize both the quality of care and the quality of life for members.
• Coordinate with the Utilization Management (UM) department on concurrent and retrospective review.
• Follow up with assigned nurses for clinical updates to the care plan.

Service Authorization

• Prior approve requests for additional services based on assessments and using evidence-based standards.
• Refer denial, reduction, or limitation of service requests to the Medical Director.

Documentation & Communication

• Document coordination notes and routine contacts with members within two business days according to the level of risk assigned to them.
• Participate in team care planning meetings.

Member Services & Support

• Handle complaints that can be resolved in one day.
• Assist Customer Service and the UM department by providing records and materials needed for grievances from MLTC/MAP program members.
• Speak with members who are delinquent in their spend-down payments.
• Identify members appropriate for specialty programs.

Compliance & Collaboration

• Cooperate with all departments within .
• Perform all MLTC/MAP management activities in compliance with all regulatory agency requirements.
• Provide information on all requests from the Quality Management Department to be reviewed by the various Quality Committees.
• Complete all other tasks assigned by MLTC Department Leadership.
• Participate in the department's rotating on-call schedule (being on-call as assigned among the care team).

Required Education, Training & Professional Experience

• Bachelor's Degree required.
• BSN preferred.
• 5 Years RN Experience which includes Two (2) to three (3) years of clinical experience in:
  • Certified Home Health Agency (CHHA)
  • Lombardi Program
  • Managed Long Term Care (MLTC)
  • Medicaid Advantage Plus (MAP) Program

Licensure and/or Certification Required

• Active New York State Registered Nurse (RN) License.

Professional Competencies

• Integrity and Trust
• Customer Service Focus
• Functional/Technical Skills
• Written Communication
• Oral Communication