Remote Nurse Case Manager — Disability Claims Expert

New York Life Insurance Co.; New York (NY); Remote; USD 89,000 - 115,000; Full time

Job summary

New York Life Insurance Co. is seeking a licensed RN to serve as Nurse Case Manager for STD/LTD claims in a fully remote role.

You will review clinical documentation, assess functional impairment, and collaborate with claim managers, providers, and internal consultants to support timely claim evaluations and return-to-work decisions. The ideal candidate has 3–5 years of clinical nursing experience including behavioral health, knowledge of medical and behavioral health diagnoses and treatments,

Qualifications

• Current, unrestricted RN license in the state of residence and, where applicable, the state of employment.
• Three to five years of clinical nursing experience, including behavioral health.
• Knowledge of medical and behavioral health diagnoses, treatment modalities, psychopharmacology, and recovery principles.
• Experience reviewing and analyzing medical records, behavioral health documentation, diagnostic findings, and treatment plans.
• Proficiency with Microsoft Office applications, electronic documentation systems, and other technology platforms used to support clinical review and case management.

Responsibilities

• Conduct comprehensive clinical reviews of STD and LTD claims involving medical, surgical, behavioral health, and co-occurring conditions.
• Identify inconsistencies and gaps in clinical information; formulate focused clinical questions; recommend next steps for clarification or additional records.
• Provide clear, objective clinical recommendations to support claim evaluation and return-to-work considerations.
• Serve as a clinical resource by educating and consulting with Claim Managers and internal/external partners.
• Document clinical findings and rationale in alignment with policies and regulatory requirements.
• Participate in quality assurance initiatives and continuous process improvement.

Skills

RN license

Clinical nursing experience

Behavioral health experience

Medical records review

MS Office / EMR systems

Education

BSN preferred

Tools

Microsoft Office

Electronic documentation systems (EMR)

Job description

New York Life Insurance Co. is seeking a licensed RN to serve as Nurse Case Manager for STD/LTD claims in a fully remote role.

You will review clinical documentation, assess functional impairment, and collaborate with claim managers, providers, and internal consultants to support timely claim evaluations and return-to-work decisions. The ideal candidate has 3–5 years of clinical nursing experience including behavioral health, knowledge of medical and behavioral health diagnoses and treatments,