Care Manager

Pride Health; New York (NY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Healthcare coverage

401(k) retirement savings

Life & disability insurance

Employee discounts with preferred vend

Job summary

Pride Health is seeking a qualified Care Manager – ED in New York, NY. The role coordinates care, supports transitions of care, and develops individualized care plans for members, collaborating with interdisciplinary teams to optimize health outcomes.

The ideal candidate has at least two years of care management experience, strong clinical assessment and communication skills, and holds an active New York RN license. This is a hybrid position with Monday–Friday hours.

Qualifications

• 2+ years care management experience in a healthcare setting or managed care organization.
• Active NY RN license and current registration, NYSED.
• Ability to read, interpret, and evaluate medical records, claims data, pharmacy records, laboratory reports, and prescriptions.
• Strong communication, clinical assessment, critical-thinking, and problem-solving skills.

Responsibilities

• Coordinate care management during transitions of care.
• Conduct transition-of-care assessments for clinical, psychosocial, financial, environmental, and social needs.
• Perform medication reconciliation and support adherence.
• Develop, implement, and evaluate individualized, member-centered care plans with members and teams.
• Participate in interdisciplinary rounds and share care plans with PCPs and healthcare professionals.
• Identify gaps in care and social determinants affecting treatment.
• Connect members with community resources and organizational supports.

Skills

Care coordination

Transitions of care

Clinical assessment

Communication

Problem-solving

Education

Bachelor’s Degree

Job description

Schedule: Monday–Friday, 9:00 AM–5:00 PM

Work Arrangement: Hybrid

Education: Bachelor’s Degree Required

License: Active New York State Registered Nurse (RN) License Required

Job Description

Client is seeking a qualified Care Manager – ED to support members through effective care coordination, transitions of care, and comprehensive care management. The Care Manager will assess member needs, develop individualized care plans, coordinate services with healthcare providers and interdisciplinary teams, and connect members with appropriate clinical and community resources.

The ideal candidate will have at least two years of care management experience in a healthcare setting or managed care organization, strong clinical assessment and communication skills, and a commitment to improving health outcomes while reducing avoidable hospitalizations and healthcare costs.

Key Responsibilities

• Coordinate care management services during transitions of care.
• Conduct transition-of-care assessments to identify members’ clinical, psychosocial, financial, environmental, and social needs.
• Perform medication reconciliation and support medication adherence.
• Develop, implement, and evaluate individualized, member-centered care plans in collaboration with members, caregivers, providers, and interdisciplinary teams.
• Participate in interdisciplinary rounds and communicate care plans to primary care physicians and other healthcare professionals.
• Identify and address gaps in care, barriers to treatment, and social determinants of health.
• Connect members with appropriate community resources and organizational support services.
• Educate members and caregivers on chronic disease management, preventive care, medication safety, home safety, and self-management strategies.
• Support complex care management by promoting access to appropriate services and helping reduce unnecessary hospitalizations.
• Advocate for members by helping them understand treatment options and make informed healthcare decisions.Address barriers to care, including language differences, cognitive limitations, stress, financial challenges, and limited social support.
• Review and interpret medical records, claims data, pharmacy information, laboratory reports, and prescriptions.
• Maintain accurate, timely, and comprehensive clinical and non-clinical documentation in care management systems.
• Comply with organizational policies, privacy requirements, mandatory training, and professional competency standards.
• Perform other duties as assigned by leadership.

Required Qualifications

• Minimum of 2 years of care management experience in a healthcare setting or managed care organization.
• Active and valid New York State Registered Professional Nurse (RN) license and current registration, issued by the New York State Education Department (NYSED).
• Ability to read, interpret, and evaluate medical records, claims data, pharmacy records, laboratory reports, and prescriptions.
• Strong communication, clinical assessment, critical-thinking, and problem-solving skills.
• Ability to collaborate effectively with members, caregivers, healthcare providers, interdisciplinary teams, and organizational leadership.
• Knowledge of care coordination, transitions of care, chronic disease management, medication reconciliation, and community resource referrals.
• Ability to maintain accurate documentation and manage multiple member needs effectively.

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

Pride-Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Pride-Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.