RN Care Manager: Care Coordination & Transitions

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

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.