Care Manager: Utilization & Care Coordination

MetroPlus; New York (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

MetroPlus in New York is seeking a Care Manager responsible for managing both simple and complex medical cases to ensure high-quality patient care outcomes. The role involves coordinating services and evaluating care plans to minimize unnecessary medical expenses.

The ideal candidate must have a relevant New York State license and 2-5 years of clinical experience in healthcare settings. Strong communication and analytical skills are essential for success in this position.

Qualifications

• 2-5 years' clinical experience in an acute or applicable care setting.
• UM/UR experience in managed care or hospital setting required.

Responsibilities

• Perform care management, including hospital admission certification and discharge planning.
• Oversee coordination of healthcare services for members requiring care management.
• Evaluate and approve care following established criteria.

Skills

Integrity and Trust

Customer Focus

Communication Skills

Analytical Skills

Knowledge of Computer Systems

Education

New York State license as Registered Nurse, License Practical Nurse, or Physical Therapist

High School Diploma or General Equivalency Diploma (GED)

Job description

MetroPlus in New York is seeking a Care Manager responsible for managing both simple and complex medical cases to ensure high-quality patient care outcomes. The role involves coordinating services and evaluating care plans to minimize unnecessary medical expenses.

The ideal candidate must have a relevant New York State license and 2-5 years of clinical experience in healthcare settings. Strong communication and analytical skills are essential for success in this position.