Care Coordination & Utilization Analyst

ViziRecruiter,LLC.; City of Yonkers (NY); On-site; USD 65,000 - 98,000; Full time

Job summary

ViziRecruiter LLC is seeking a Care Management Analyst in New York, NY to support complex and chronic care programs under licensed supervision. You will gather data from members, caregivers, and providers, review utilization and benefits, and escalate cases for clinical intervention as needed.

The role emphasizes PBM prior authorizations, documentation accuracy, and collaboration with interdisciplinary teams to ensure high-quality, cost-effective care.

Qualifications

• High School Diploma or GED required.
• Bachelor’s or Master’s degree preferred (Nursing, Healthcare Administration, Public Health, or another health or human services field).
• Current LPN licensure and registration in NY State required.

Responsibilities

• Coordinate operational activities supporting complex care, chronic care, palliative care, and care transitions programs.
• Process and manage medication prior authorizations through PBMs, health plans, and specialty pharmacies.
• Collect, review, and organize clinical and administrative information from members, caregivers, providers, and EHRs.
• Evaluate benefit eligibility and utilization information against policies and clinical guidelines.
• Manage assigned care management processes and workflows with timely follow-up.
• Collaborate with interdisciplinary teams to facilitate appropriate interventions and continuity of care.
• Maintain accurate documentation within care management and utilization management systems.

Skills

Analytical thinking

Time management

Communication skills

Interpersonal skills

Confidentiality

Microsoft Office

Data entry

EHR systems

Web-based applications

Education

LPN licensure NY

Bachelor’s or Master’s degree preferred

High School Diploma or GED

Tools

Case management software

Utilization management software

PBMs & PBM portals

Electronic fax systems

Job description

ViziRecruiter LLC is seeking a Care Management Analyst in New York, NY to support complex and chronic care programs under licensed supervision. You will gather data from members, caregivers, and providers, review utilization and benefits, and escalate cases for clinical intervention as needed.

The role emphasizes PBM prior authorizations, documentation accuracy, and collaboration with interdisciplinary teams to ensure high-quality, cost-effective care.