Nurse Utilization Case Manager — Care Coordination & Compliance

1199seiubenefits; New York (NY); On-site; USD 95,000 - 125,000; Full time

Job summary

A healthcare organization in New York is seeking a Registered Nurse for Utilization Management. The role involves assessing, planning, and coordinating service delivery through case management. Candidates must hold a Bachelor's degree and a valid NY RN license, along with a minimum of three years of Medical/Surgical and two years of Utilization Management experience. Strong problem-solving and communication skills are essential, with a focus on maintaining compliance and quality outcomes.

Qualifications

• Bachelor’s degree and Valid New York State Registered Nurse (RN) required.
• Minimum three years Medical/Surgical experience plus two years Utilization Management experience required.
• Proficient in Utilization Management criteria and Medicare guidelines.

Responsibilities

• Assess, plan and provide ongoing coordination through case management.
• Perform medical necessity reviews to ensure compliance.
• Maintain accurate records of patient interactions.

Skills

Clinical assessment

Care planning skills

Problem-solving

Verbal and written communication

Utilization Management criteria application

Microsoft Office skills

Education

Bachelor’s degree

Valid New York State Registered Nurse (RN) license

Job description

A healthcare organization in New York is seeking a Registered Nurse for Utilization Management. The role involves assessing, planning, and coordinating service delivery through case management. Candidates must hold a Bachelor's degree and a valid NY RN license, along with a minimum of three years of Medical/Surgical and two years of Utilization Management experience. Strong problem-solving and communication skills are essential, with a focus on maintaining compliance and quality outcomes.