Case Manager, RN or Licensed Behavioral Health (Multiple Openings!)

Univera Healthcare; Buffalo (NY); On-site; USD 62,400 - 117,622; Full time

Job summary

Univera Healthcare in Buffalo seeks a case manager to conduct program activities per regulatory standards, assess member needs, and coordinate care with providers. You will implement case-management processes, educate members, and support goal achievement through collaboration with health professionals and community resources.

This role requires an RN, dietitian, or related licensure, plus 3+ years of clinical case-management experience. Strong communication and MS Office skills are essential.

Qualifications

• Bachelor's degree preferred; Associate's degree required.
• Active NYS RN, Registered Dietitian, Physical Therapist licensure, LMSW, LCSW, or LMHC required.
• Minimum three years of clinical experience; case-management experience preferred.
• Proficiency with Microsoft Office Suite; ability to interpret managed care benefit plans.

Responsibilities

• Conduct case management activities per standards and regulations.
• Implement the Case Management Process: identification, opening, assessment, planning, intervention, outcome measurement, closure.
• Screen members, determine service appropriateness, and coordinate care.
• Use motivational interviewing to support member goals and communicate essential information.
• Collaborate with physicians and providers to develop and adjust care plans.

Skills

Strong communication

Teamwork

Multitasking

Independent work

Clinical case management

Education

Associate's degree

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member’s case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options through collaboration with providers and community-based resources.

Responsibilities

• Conduct case management program activities per departmental and regulatory standards.
• Implement the Case Management Process: case identification, opening, member assessment, education, care planning, intervention execution, outcome measurement, closure, and review.
• Screen members within defined populations, apply case‑management criteria, and determine appropriateness for services.
• Initiate and manage cases using motivational interviewing and ensure essential information is communicated to members, supporting achievement of health goals.
• Collaborate with physicians and other health care providers to develop interdisciplinary care plans, coordinate services, evaluate effectiveness, and modify plans as needed.
• Assess member/caregiver knowledge, initiate education interventions, and provide resources for managing health across the continuum of care.
• Act as liaison between providers and community resources to ensure consistent, high‑quality care delivery.
• Participate in interdisciplinary coordination (Utilization Management, Quality, Behavioral Health, Pharmacy, Dietetics, Respiratory Therapy) to support member outcomes.
• Maintain confidentiality and adhere to corporate privacy policies and information management procedures.
• Pursue continuing education and meet or exceed minimum requirements in accordance with departmental and certification standards.
• Promote other health plan programs such as preventive health, web‑based self‑management tools, and digital health applications.
• Engage with internal and external stakeholders for value‑based payment programs, including accountable cost and quality arrangements (ACQA).
• Demonstrate integrity and uphold the company’s mission, values, and code of conduct.
• Maintain high regard for member privacy in accordance with corporate policies.
• Participate in the orientation of new staff and other assigned functions.
• Attain regular and reliable attendance.
• Level I additional responsibilities:
  • Handle physical health member clinical management programs.
  • Stay current on CMSA Standards, NCQA Standards, and related regulatory requirements.
  • Implement case‑management process in line with departmental policies, ensuring compliance with NYS DOH, CMS regulations and other applicable regulations.
• Level II additional responsibilities:
  • Manage all member clinical condition management programs.
  • Offer process improvement suggestions and solve complex issues.
  • Mentor junior staff and provide coaching.
  • Meet or exceed productivity and performance metrics, including audit results.
  • Manage more complex assignments and larger caseloads.
  • Display leadership skills and serve as a positive role model.
• Level III additional responsibilities:
  • Lead process management and documentation: identify and implement new processes for productivity and efficiency, update departmental policies, and develop performance improvement guidelines.
  • Act as subject‑matter expert for escalations and resolve issues directly with operational and clinical staff.
  • Mentor and provide guidance to the Case Management Department staff, serving as a resource to members and providers.
  • Provide backup for the Supervisor/Manager when necessary, including training opportunities for all staff and liaison roles with other departments.
  • Ensure compliance with all regulatory requirements, serving as internal auditor when required.
  • Oversee all aspects of the Case Management Department, including quality, productivity, utilization performance, and educational needs.

Qualifications

• Associate's degree required; Bachelor's degree preferred.
• Active NYS RN, Registered Dietitian, Physical Therapist licensure, LMSW, LCSW, or LMHC required.
• Minimum three years of clinical experience; case‑management experience preferred.
• Proficiency with Microsoft Office Suite.
• Experience interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently on a daily basis.
• Deliver efficient, effective, and seamless care to members.
• For FEP line of business incumbents, Case Management Certification required within two (2) years of hire or promotion.
• For Hospital to Home program incumbents, active NYS RN license required with three years of behavioral health experience; or LMSW, LCSW, or LMHC required.
• Level II additional qualifications:
  • A minimum of 2 years in a case‑management position.
  • Case Management Certification preferred.
  • Demonstrated ability to escalate to management when necessary.
  • Proficiency in all related technology and documentation requirements.
  • Consistently meet or exceed all performance metrics.
• Level III additional qualifications:
  • At least 5 years in a case‑management or similar subject‑matter expert position.
  • Case Management Certification required.
  • Broad understanding across multiple areas (UM and CM).
  • Expertise in handling complex assignments and highly visible issues.
  • Ability to lead training of new staff.
  • Demonstrated presentation skills.

Physical Requirements

• Ability to travel and work long hours on a computer.
• Flexibility to accommodate member discussions as needed.

Compensation

• Level I: $62,400 – $96,081
• Level II: $62,400 – $106,929
• Level III: $65,346 – $117,622

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.