Care Manager: Patient-Centric Case Coordination

Talentify; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

SBH Health is seeking an experienced RN for a Case Management role in New York. You will manage denials, coordinate appeals, and work with physicians and care teams to ensure appropriate inpatient and outpatient care.

Responsibilities include reviewing Interqual criteria, assisting with authorizations, and maintaining comprehensive documentation while supporting patient-centered care and regulatory compliance.

Qualifications

• Graduate from a recognized Nursing School with NY RN license.
• PRI certification within one year of hire.
• 3–5 years clinical nursing experience; 2+ years case management.
• Denials/appeals and managed care experience preferred.

Responsibilities

• Promotes a safe, cooperative and professional healthcare environment.
• Communicates with patients, families and staff about SBH services.
• Evaluates concurrent denials and initiates expedited appeals when needed.
• Reviews Interqual criteria to determine appropriateness of care.
• Assists social workers and case managers with authorizations for placement.
• Documents outcomes and maintains regulatory communications and records.
• Prepares administrative reports and tracks denials and appeals.
• Supports department goals and uses data for planning and decision making.

Skills

PRI certification

RN license NY

Denials/Appeals

Education

Nursing degree

Bachelor's degree preferred

Tools

HBO

EMR

Interqual

CERMe

ACM

Job description

SBH Health is seeking an experienced RN for a Case Management role in New York. You will manage denials, coordinate appeals, and work with physicians and care teams to ensure appropriate inpatient and outpatient care.

Responsibilities include reviewing Interqual criteria, assisting with authorizations, and maintaining comprehensive documentation while supporting patient-centered care and regulatory compliance.