RN Care Manager

Title: RN – Care Manager – Managed Long-Term Care (MLTC/MAP)
Location: New York, NY 10004
Duration: 8 weeks (December 7, 2026 – January 30, 2027)
Shift: Day Shift, 9:00 AM – 5:00 PM
Schedule: Monday–Friday, 5 days/week, 7 hours/day, 35 hours/week. Full-time. Hybrid work arrangement. On-call rotation required.
Pay: $60/hr.

Note: Non-patient-facing position.

Requirements

• Active New York State Registered Nurse (RN) license.

• Bachelor's degree required; BSN preferred.

• Minimum 5 years of clinical experience as a Registered Nurse.

• 2–3 years of clinical experience in a Certified Home Health Agency (CHHA), Lombardi program, and/or MLTC or MAP program.

• Experience in Utilization Management, Case Management, Care Coordination, Utilization Review, and Discharge Planning.

• Bilingual English/Spanish proficiency required (speaking, reading, and writing).

• PRI and Screen certification required within 3 months of employment.

• Computer literacy required.

• Leadership experience preferred.

• Master's degree preferred.

• Certification in Case Management preferred.

Responsibilities

• Review and evaluate member assessments and Uniform Assessment System (UAS) information for MLTC and MAP programs.

• Develop and communicate individualized care plans in partnership with members, families, caregivers, primary care physicians, and other providers.

• Identify member risk factors, strengths, challenges, service needs, and appropriate risk categories.

• Coordinate with primary care physicians to review assessment findings and address clinical concerns.

• Develop formal care plans covering required services, including the member's disaster plan.

• Monitor members at least monthly, primarily by telephone and face-to-face when necessary.

• Identify clinical issues requiring immediate assessment or treatment to reduce unnecessary hospitalizations, emergency department visits, and nursing home admissions.

• Identify opportunities to improve preventive and chronic disease care.

• Review and approve requests for additional services based on assessments and evidence-based standards; refer denials, reductions, or limitations to the Medical Director.

• Coordinate services within and outside provider networks, including discharge planning from acute and alternate care settings.

• Coordinate care across the continuum and collaborate with Utilization Management on concurrent and retrospective reviews.

• Follow up with assigned nurses for clinical updates to care plans.

• Document coordination notes and routine member contacts within two business days, according to assigned risk levels.

• Participate in team care planning meetings and address complaints that can be resolved within one day.

• Support Customer Service and Utilization Management with records and materials needed for member grievances.

• Communicate with members regarding delinquent spend-down payments.

• Identify members appropriate for specialty programs.

• Ensure MLTC/MAP management activities comply with regulatory requirements.

• Provide information requested by Quality Management for review by Quality committees.

• Participate in the department's rotating on-call schedule.

• Perform other duties assigned by department leadership.