Case Management Nurse

RN Care Manager – MLTC/MAP

Location: New York, NY

Schedule: Monday–Friday | 9:00 AM – 5:00 PM (35 hours/week)

Contract Duration: 8+ weeks (extendable)

Position Overview:

The Care Manager is responsible for developing, facilitating, monitoring, and communicating individualized care plans in partnership with members, families, caregivers, physicians, and interdisciplinary teams. Using assessments completed by the Assessment Nurse, the Care Manager identifies risk factors, strengths, challenges, and service needs to support safe and effective care in the community setting.

Key Responsibilities:

• Review and evaluate UAS and assessment data for MLTC/MAP members

• Develop care plans in collaboration with members, caregivers, PCPs, and interdisciplinary teams

• Establish and maintain working relationships with PCPs to discuss member care needs

• Identify risk factors and assign appropriate risk levels for members

• Develop and implement comprehensive care plans, including disaster preparedness plans

• Monitor member status at least monthly via phone or face-to-face visits as needed

• Identify high-risk clinical issues requiring urgent intervention to prevent hospitalizations or ED visits

• Coordinate services across providers and settings, including discharge planning and transitions of care

• Prior authorize services using evidence-based standards and refer complex cases to Medical Director

• Coordinate with Utilization Management (UM) for concurrent and retrospective reviews

• Ensure members receive preventive and chronic disease care services

• Document care coordination activities within two business days based on assigned risk level

• Participate in interdisciplinary team meetings and care planning discussions

• Support grievance resolution, customer service coordination, and clinical documentation requests

• Identify members eligible for specialty care programs

• Ensure compliance with MLTC/MAP regulatory and organizational requirements

• Participate in departmental on-call rotation and additional leadership-assigned duties

Required Qualifications:

• Active NY RN License

• Minimum 5 years of clinical nursing experience

• BSN required

• Experience in Care Coordination, Utilization Review, and Discharge Planning

• Experience with MLTC/MAP strongly required

• Computer literacy required

• PRI and Screen Certification required within 3 months

Benefits:

Pride Health offers eligible employees comprehensive healthcare coverage including medical, dental, and vision plans, supplemental insurance (accident, critical illness, hospital indemnity), 401(k) retirement savings, life and disability insurance, employee assistance programs, legal support, auto/home insurance, pet insurance, and employee discounts with preferred vendors.