MLTC Hybrid Case Manager

We are seeking a compassionate and experienced MLTC Case Manager to support members enrolled in a Managed Long-Term Care (MLTC) program. The Case Manager will be responsible for coordinating services, conducting assessments, developing care plans, and ensuring members receive appropriate medical, social, and community-based services to support their health and independence.

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The ideal candidate will have experience working with elderly and/or disabled populations, strong care coordination skills, and knowledge of New York State MLTC regulations.

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Key Responsibilities

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• Conduct initial and ongoing member assessments to identify clinical, psychosocial, environmental, and support needs.
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• Develop, implement, and monitor individualized plans of care.
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• Coordinate long-term services and supports (LTSS) for MLTC members.
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• Collaborate with physicians, home care providers, family members, community agencies, and interdisciplinary team members.
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• Monitor service delivery and ensure members receive appropriate and timely care.
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• Maintain regular contact with members through telephonic and in-person visits as required.
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• Educate members and caregivers regarding available benefits, services, and community resources.
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• Identify barriers to care and implement interventions to improve health outcomes.
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• Ensure compliance with MLTC, CMS, and New York State Department of Health regulations.
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• Accurately document assessments, care plans, interventions, and case activities in the electronic medical record.
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• Participate in interdisciplinary team meetings and case conferences.
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• Support transitions of care, hospital discharges, and prevention of avoidable hospitalizations.
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Qualifications

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Required

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• Bachelor's Degree in Nursing, Social Work, Human Services, or related field.
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• Active New York State RN license preferred.
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• Minimum 1-2 years of case management, care coordination, MLTC, managed care, home care, or healthcare experience.
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• Knowledge of Managed Long-Term Care (MLTC), Medicaid, and community-based services.
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• Strong assessment, communication, and organizational skills.
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• Experience working with geriatric, disabled, or medically complex populations.
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• Ability to travel within assigned territory as needed.
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Preferred

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• Previous MLTC experience.
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