CARE MANAGEMENT ANALYST CMO

Montefiore Einstein; City of Yonkers (NY); On-site; USD 56,000 - 70,000; Full time

Job summary

Montefiore Medical Center in Yonkers, NY, is seeking a Care Management Analyst to support operational functions for complex, chronic, palliative care, and care transitions programs. You will coordinate activities, gather information from members, caregivers, physicians, and EHRs, and manage medication prior authorizations with PBMs and health plans.

The role requires an LPN license in NY and typically a relevant health degree; strong analytical, organizational, and communication skills are

Qualifications

• High School Diploma or GED required.
• Bachelor’s or Master’s degree preferred in health-related fields.
• Current LPN licensure and NY State registration 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 electronic health records.
• Evaluate benefit eligibility and utilization information according to policies and clinical guidelines.
• Manage assigned care management processes with timely follow-up and documentation.
• Collaborate with interdisciplinary care management teams to facilitate interventions and continuity of care.
• Maintain documentation within care management and utilization management systems.
• Ensure compliance with organizational, regulatory, and payer requirements while maintaining confidentiality.

Skills

Analytical thinking

Time management

Communication

Interpersonal skills

Customer service

Education

Bachelor’s or Master’s degree preferred

LPN licensure in NY State required

Tools

Microsoft Office Suite

Electronic Health Records (EHR) systems

PBM/claims systems

Job description

City/State:Yonkers, New YorkGrant Funded:NoDepartment:NCM - Central Intake UnitWork Shift:DayWork Days:MON-FRIScheduled Hours:8:30 AM-5 PMScheduled Daily Hours:7.5 HOURSPay Range:$56,000.00-$70,000.00Job SummaryUnder the supervision of a licensed or certified clinical professional, the Care Management Analyst (CMA) is responsible for supporting the operational functions of care management programs, including complex care, chronic care, palliative care, and care transitions. The Care Management Analyst coordinates and manages key care management processes to ensure members receive timely, appropriate, and cost-effective healthcare services while adhering to organizational policies, regulatory requirements, and payer guidelines.The CMA gathers, reviews, and organizes information from multiple sources, including members, caregivers, physicians, clinical information systems, and electronic health records (EHRs). Using established protocols, the CMA evaluates information related to utilization and benefit application, facilitates care coordination activities, and escalates cases requiring clinical intervention to the appropriate care management staff. A primary responsibility of this role is managing medication prior authorizations through Pharmacy Benefit Managers (PBMs), ensuring timely access to prescribed therapies while meeting payer requirements.Essential ResponsibilitiesCoordinate operational activities supporting complex care, chronic care, palliative care, and care transitions programs.Process and manage medication prior authorizations through Pharmacy Benefit Managers (PBMs), health plans, and specialty pharmacies.Collect, review, and organize clinical and administrative information from members, caregivers, providers, and electronic health records.Evaluate benefit eligibility and utilization information in accordance with established policies, procedures, and clinical guidelines.Manage assigned care management processes and/or a designated caseload while ensuring timely follow-up and documentation.Collaborate with interdisciplinary care management teams to facilitate appropriate interventions and continuity of care.Serve as a resource to team members, physicians, providers, members, caregivers, and internal departments regarding care management processes.Maintain accurate documentation within care management and utilization management systems.Ensure compliance with organizational, regulatory, and payer requirements while maintaining confidentiality of member information.Support quality improvement initiatives and other departmental operational activities as assigned.QualificationsEducation/ LicensureHigh School Diploma or GED required.Bachelor’s or master’s degree preferred (Nursing, Healthcare Administration, Public Health, or another health or human services fields)Current LPN licensure and registration in NY State required.ExperienceExperience processing medication prior authorizations with Pharmacy Benefit Managers (PBMs), health plans, or specialty pharmacies strongly preferred.Experience in medical management within a managed healthcare environment preferred.Previous case management, utilization management, care coordination, or population health experience preferred.Experience working with electronic health records (EHRs) and clinical documentation systems preferred.Technical SkillsProficiency in Microsoft Office Suite (Word, Excel, Outlook)Experience with case management and utilization management softwareStrong data entry and keyboarding skillsFamiliarity with electronic health records (EHRs)Experience using electronic fax systems and automated call distribution systemsAbility to navigate web-based healthcare applications and databasesExperience operating standard office equipment, including scanners and copiersKnowledge, Skills & AbilitiesStrong analytical and critical thinking skillsExcellent organizational and time management abilitiesEffective written and verbal communication skillsAbility to prioritize multiple assignments in a fast-paced environmentStrong customer service and interpersonal skillsAbility to maintain confidentiality and exercise sound judgmentAbility to work collaboratively with interdisciplinary teams while managing multiple prioritiesMontefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.