RN Care Manager

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

Benefits offered by this job

Healthcare coverage (medical, dental,

Vision plans

401(k) retirement savings

Life & disability insurance

Employee assistance program

Employee discounts with vendors

Job summary

Pride Health is seeking a seasoned RN in New York to lead care coordination and complex case management. You will assess member needs, formulate individualized care plans with families and providers, and drive outcomes through collaborative teamwork.

Role emphasizes discharge planning, transitions of care, and patient education while leveraging data to optimize care and reduce hospitalizations. NY license required; bilingual in Spanish preferred.

Qualifications

• RN license in the State of New York is required.
• Master’s Degree and bilingual Spanish certification in case management preferred.
• Minimum 5 years of clinical RN experience; leadership experience preferred.
• Experience in care coordination, utilization review and discharge planning.
• Minimum 2 years in a healthcare, care management or managed care setting.

Responsibilities

• Assess and evaluate members’ clinical, psychosocial, financial and environmental needs and develop individualized plans of care with members, caregivers and providers.
• Engage members in collaborative relationships, support self-management, address gaps in care and social determinants of health, and link to resources.
• Participate in interdisciplinary rounds, communicate plans of care to Primary Care Physicians, and provide care management support during transitions of care.
• Provide chronic disease education, preventive care, medication management, home safety guidance and complex care management to reduce hospitalizations.
• Advocate for members, address challenges and treatment options, use critical thinking and track outcomes and clinical information using data.
• Maintain accurate clinical and non-clinical documentation including medical records, claims data, pharmacy, lab reports, prescriptions and CM System documentation.

Skills

RN license

Leadership experience

Care Coordination

Utilization Review

Discharge Planning

Medical records interpretation

Claims data interpretation

Pharmacy information interpretation

Labs interpretation

Prescriptions interpretation

Work with members and caregivers

Education

Master’s Degree in Case Management

Bilingual Spanish Certification in Case Management

Job description

• RN license as a Registered Nurse in the State of New York required.
• Master’s Degree and Bilingual Spanish Certification in Case Management preferred.

Skills:

Minimum 5 years of clinical experience as a Registered Nurse (RN); leadership experience preferred.

Experience with Care Coordination, Utilization Review, and Discharge Planning.

Minimum 2 years of experience in a healthcare, Care Management, or Managed Care setting.

Ability to read and interpret medical records, claims data, pharmacy information, lab reports, and prescriptions.

Ability to work closely with members and caregivers

Duties:

Assess and evaluate members’ clinical, psychosocial, financial, and environmental needs and develop individualized plans of care with members, caregivers, and healthcare providers.

Engage members in collaborative relationships, support self-management, address gaps in care and social determinants of health, and link members to available resources.

Participate in interdisciplinary rounds, communicate plans of care to Primary Care Physicians, and provide care management support during Transitions of Care.

Provide chronic disease education, preventive care, medication management, home safety guidance, and complex care management, including reducing unnecessary hospitalizations.

Advocate for members, address challenges and treatment options, use critical thinking and judgment, and track outcomes and clinical information using data.

Maintain accurate and current clinical and non-clinical documentation, including medical records, claims data, pharmacy, lab reports, prescriptions, and Care Management System documentation.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates:

Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.