Case Manager

Overview

• Join a leading healthcare organization as a Case Manager specializing in pre-authorization processes and care coordination.
• Contribute to structured care management processes in a supportive and collaborative environment.
• Leverage your nursing expertise to ensure compliance with Medicare and Medicaid guidelines.
• Engage in interdisciplinary collaboration to optimize member care plans and service delivery.
• Enjoy a hybrid training period followed by remote work flexibility for enhanced work-life balance.
• Utilize your skills in utilization management within Managed Care and MLTC environments.
• Participate in a role designed for goal-oriented planning without heavy caseload management.
• Contribute to a mission-driven organization focused on delivering high-quality healthcare services.

Key Responsibilities & Duties

• Coordinate service requests adhering to Medicare, NYS Medicaid, and organizational criteria.
• Collaborate with care managers, assessment nurses, and physicians to ensure timely service provision.
• Update individualized care plans to reflect members' current health conditions accurately.
• Organize UAS NY assessments to provide comprehensive evaluations of members' needs.
• Apply knowledge of utilization management processes and interqual standards effectively.
• Ensure compliance with Medicare and Medicaid regulations in service delivery and documentation.
• Utilize Windows, Word, and Excel for accurate documentation and reporting.
• Maintain adherence to current medical practice standards and healthcare systems.

Job Requirements

• Associate of Science (AS) degree in Nursing; Bachelor's degree preferred.
• Minimum 2 years of nursing experience in long-term care, managed care, or geriatrics.
• Prior experience in interdisciplinary service delivery environments preferred.
• Strong knowledge of Medicare and Medicaid regulations and utilization management processes.
• Proficiency in interqual standards and care management practices.
• Working knowledge of Windows, Word, and Excel software.
• Excellent assessment skills and familiarity with healthcare delivery systems.
• Ability to work remotely 4 days per week following hybrid training completion.