Care Manager: Hospital & Community Care Coordination

MetroPlusHealth; New York (NY); On-site; USD 80,000 - 110,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Care Manager to coordinate care for both inpatient and outpatient settings. You will work under the VP Clinical Services to manage simple and complex medical cases, ensure high-quality outcomes, and minimize unnecessary expenses by coordinating services and evaluating care plans.

The role requires NY licensure (RN/LPN/PT), 2–5 years of clinical experience, and UM/UR experience in managed care or hospital settings.

Qualifications

• Active New York State license as RN, LPN, or PT.
• 2–5 years of clinical experience in an acute or relevant care setting.
• UM/UR experience in managed care or hospital setting required.

Responsibilities

• Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review.
• Oversee coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management.
• Interacts with members’ PCP and other providers; approves care meeting criteria; refers others to Medical Director.
• Identifies utilization trends and potential member needs by generating encounter and pharmacy data reports.
• Evaluate member needs for referred cases and assist departments with utilization management issues.
• Performs all UM activities in compliance with regulatory requirements.
• Conducts medical record reviews as appropriate and participates in Medical Management grand rounds.
• Performs other duties as assigned.

Skills

Clinical experience

Utilization management

Strong communication

Analytical skills

Education

New York State license (RN/LPN/PT)

GED

Job description

MetroPlusHealth in New York is seeking a Care Manager to coordinate care for both inpatient and outpatient settings. You will work under the VP Clinical Services to manage simple and complex medical cases, ensure high-quality outcomes, and minimize unnecessary expenses by coordinating services and evaluating care plans.

The role requires NY licensure (RN/LPN/PT), 2–5 years of clinical experience, and UM/UR experience in managed care or hospital settings.