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Case Manager (RN) job in New York at The Execu | Search Group

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Case Manager (RN) at The Execu | Search Group

Case Manager (RN)

The Execu | Search Group New York, NY Full Time
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A New York City services organization is currently seeking a licensed Registered Nurse (RN) to join their team as their new Case Manager. In this role, the Case Manager (RN) will be responsible for assessing, planning and providing ongoing coordination and management of service delivery through an integrated case management approach.


The Case Manager (RN) will:
  • Provide comprehensive telephonic case management to targeted population who are at risk for admission and to medically complex patients to develop a tailored plan of care that supports the needs of the patients, influences adherence to treatment, assist with discharge planning and care coordination to ensure optimal outcomes
  • Communicate effectively with members, Physicians, and providers; facilitate, advocate, and educate on the disease process
  • Navigate within care management application and document management systems and maintain accurate documentation of case management assessment, planning, goals and interventions
  • Act as a Subject Matter Expert based on particular disease management areas of expertise: lead ongoing staff training, provide information regarding medications updates and continued education
  • Interpret reports, understand trends and target specific high risk population, provide recommendations, generate outcomes.
  • Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources
  • Authorize vendor services using clinically proven criteria to make consistent care decisions
  • Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
  • Abide by and support the care management programs in order to ensure quality and efficient clinical operations
  • Perform additional duties and projects, as assigned by management


  • 3+ years of Medical-Surgical experience; 2+ years of experience in a Case Management and/or Disease Management 
  • Bachelor's Degree in a related field
  • Valid NYS Registered Nurse (RN) license
  • Strong knowledge of Clinical evidence-based guidelines, industry standard Case Management criteria (Milliman Care Guidelines, Interqual), Medicare and Medicaid coverage guidelines, Health Claims processing, Medical Coding and interpreting provider contracts
  • Solid assessment, clinical, and documentation skills
  • Patient oriented
  • Great interpersonal skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Highly organized
Desired Skills:
  • Bachelor's Degree in Nursing
  • Certification in Case Management a plus
  • Knowledge of HEDIS, NCQA, and/or QARR

Recommended Skills

  • Attention To Detail
  • Care Coordination
  • Case Management
  • Certified Nurse Practitioner
  • Claim Processing
  • Clinical Works
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Job ID: 238133

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