Care Manager

Shift - Hybrid 9 AM- 5 PM (Tentative )
Pay - $60/hr - $65/hr.

Summary
Client is committed to empowering New Yorkers by uniting communities through
care. We believe that Health care is a right, not a privilege. If you have compassion and a
collaborative spirit, work with us. You can come to work being proud of what you do every day.
The Care Manager develops, facilitates, monitors, and communicates a care plan in partnership
with the member, their family or significant other, primary caregiver, the primary and/or the
attending physicians, and various providers. Using the assessments and interview done by the
Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service
needs of the member as they strive to keep them safe and well in their community setting.

Product of Role & Responsibilities:
Review and evaluate the assessment and UAS information for members in the MLTC
and MAP lines of business.
Develop a working relationship with the PCP to be able to contact and discuss the care
of the member with them.
Review assessment findings with the PCP to identify any concerns that have not been
identified by the clinical team.
Identify the risk factors and assign the risk category to the member.
As part of Care Management team, develops a formal care plan for all services needed
for the member, including the members disaster plan.
Monitor the condition of all members at least monthly, typically by telephone but via
face-to-face when necessary.
Identify clinical issues that require immediate clinical assessment and/or treatment to
reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
Identify opportunities to improve the quality of care by ensuring members receive
needed preventative and chronic disease care.
Prior approve request for additional services based on assessments and using evidence based standards refer denial, reduction, or limitation of service request to Medical
Director.
Assist members with the coordination of services both within and outside networks as
appropriate. Includes facilitating discharge from acute setting and alternate settings.
Provides Care Coordination through continuum of care.
Optimizes both the quality of care and the quality of life for the
members.
Coordinate with Utilization Management (UM) department on concurrent and
retrospective review.
Follow up with assigned nurses for clinical updates to care plan.
Document within two business days coordination notes and routine contacts with the
members according to the level of risk assigned to them.
Participate in team care planning meetings.
Handles complains that can be resolved in one day
Assists Customer Service and the UM department by providing records and materials
needed for grievances from MLTC/MAP program members
Speaks to members who are delinquent in their spend-down payments.
Cooperates with all department within
Identifies members appropriate for specialty programs.
Performs all MLTC/MAP management activities in compliance with all regulatory
agency requirements.
Provides information on all requests from Quality Management Department to be
reviewed by the various Quality committees.
Completes all other tasks assigned by MLTC Dept. Leadership.
Participates in the department on call schedule/being on call, which is rotated amongst
the care team.

Required Education, Training & Professional Experience:
Bachelors Degree required; BSN preferred.
Two (2) to three (3) years clinical experience in certified home health agency (CHHA),
Lombardi program and/or MLTC or MAP program
Licensure and/or Certification Required:
Active New York State License as Registered Nurse
Professional Competencies:
Integrity and Trust
Customer Service Focus
Functional/Technical skills
Written/Oral Communications

Schedule Start Date:
05/25/2026

Schedule Start Date:
05/25/2026

Schedule Hours Per Week:
35.00

Schedule Hours Per Day:
7.00

Schedule Notes:

Schedule Days Per Week:
5.00