Nurse Case Manager, Utilization & Care Coordination

1199SEIU Benefit and Pension Funds; New York (NY); On-site; USD 80,000 - 100,000; Full time

Job summary

A healthcare organization in New York, NY is seeking a Clinical Care Manager responsible for coordinating and managing service delivery in an integrated case management approach. The ideal candidate will have a Bachelor’s degree, a valid RN license in New York, and at least five years of related experience. Strong communication and problem-solving skills are essential, alongside proficiency in Utilization Management criteria. This role includes conducting medical necessity reviews and maintaining compliance with state regulations.

Qualifications

• Minimum three years of Medical/Surgical experience and two years in Utilization Management.
• BSN and Certification in Case Management is a plus.
• Proficient in Utilization Management criteria and medical claims processing.

Responsibilities

• Assess, plan, and manage service delivery through an integrated case management approach.
• Perform medical necessity reviews and ensure compliance.
• Maintain accurate records and submit required reports.

Skills

Communication skills

Problem-solving

Clinical assessment

Care planning skills

Organizational skills

Education

Bachelor's degree; Valid New York State Registered Nurse (RN)

Tools

Microsoft Office

Job description

A healthcare organization in New York, NY is seeking a Clinical Care Manager responsible for coordinating and managing service delivery in an integrated case management approach. The ideal candidate will have a Bachelor’s degree, a valid RN license in New York, and at least five years of related experience. Strong communication and problem-solving skills are essential, alongside proficiency in Utilization Management criteria. This role includes conducting medical necessity reviews and maintaining compliance with state regulations.