Hybrid Case Manager, Patient Financial Services & Appeals

msk; New York (NY); Hybrid; USD 125,000 - 201,000; Full time

Job summary

Memorial Sloan Kettering Cancer Center in New York is seeking a Case Manager in Patient Financial Services to navigate payer requirements, review medical necessity, manage appeals, and coordinate between patients, providers, and insurers. The role emphasizes high-volume caseload management, collaboration with physicians, and applying Medicare/Medicaid guidelines.

Schedule: Monday–Friday 9:00 AM–5:00 PM. Location: Hybrid on-site once a month; Reports To: Associate Clinical Director, Patient

Qualifications

• Bachelor's degree in Nursing and NY RN license required.
• Clinical nursing experience with healthcare delivery knowledge.
• Experience with utilization management, appeals, denials management, or prior authorization.
• Strong knowledge of Medicare/Medicaid and payer guidelines.
• Understanding of state and federal health-regulation compliance.
• Knowledge of InterQual and Milliman criteria and pharmacy coverage rules.

Responsibilities

• Review medical records and treatment plans to assess medical necessity.
• Facilitate insurance appeals and denial management with supporting documentation.
• Apply Medicare, Medicaid, and payer guidelines to coverage decisions.
• Collaborate with physicians and care teams for letters of medical necessity.
• Communicate with patients, providers, PBMs and insurers about status and coverage.
• Document outcomes, payer communications, and strategies in EHR.
• Serve as liaison between patients, clinical teams and payers.
• Research payer policies and medical literature to strengthen appeals.
• Manage a high-volume caseload with deadlines and compliance.

Skills

Chart review

Medical necessity assessment

Negotiation

Communication skills

High-volume caseload management

EHR familiarity

Microsoft Office

Education

Bachelor's degree in Nursing

NY RN license

Tools

Payer portals

Prior authorization systems

InterQual/Milliman criteria

Job description

Memorial Sloan Kettering Cancer Center in New York is seeking a Case Manager in Patient Financial Services to navigate payer requirements, review medical necessity, manage appeals, and coordinate between patients, providers, and insurers. The role emphasizes high-volume caseload management, collaboration with physicians, and applying Medicare/Medicaid guidelines.

Schedule: Monday–Friday 9:00 AM–5:00 PM. Location: Hybrid on-site once a month; Reports To: Associate Clinical Director, Patient