Case Manager II - Utilization & Care Coordination

RiseMe; New York, Indiana (NY, PA); Hybrid; USD 73,000 - 120,000; Full time

Job summary

Healthfirst HF Management Services, LLC is seeking a qualified clinical case manager in the New York area to provide comprehensive case management for assigned member caseloads, including pre-certification reviews, assessment of medical, psychological, and social needs, and coordination with PCP and other providers.

You will document determinations, advocate for members, develop and execute care plans aligned with physician treatment plans, and support the care team to improve outcomes while

Qualifications

• RN, LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or ST license
• For Medical Case Management, valid clinical license.
• Hospital/healthcare case management experience preferred.

Responsibilities

• Pre-certification reviews to evaluate medical necessity and appropriateness.
• Assessment of medical, psychological, and social issues requiring intervention.
• Coordinate care with PCPs and other providers; negotiate and authorize services as needed.
• Document all determinations, actions, and communications per guidelines.

Job description

Healthfirst HF Management Services, LLC is seeking a qualified clinical case manager in the New York area to provide comprehensive case management for assigned member caseloads, including pre-certification reviews, assessment of medical, psychological, and social needs, and coordination with PCP and other providers.

You will document determinations, advocate for members, develop and execute care plans aligned with physician treatment plans, and support the care team to improve outcomes while