New York Licensed Case Manager

Job Summary

Coordinating care plans for assigned members, the full-time New York Licensed Case Manager will conduct pre-certification, concurrent reviews, and discharge planning while ensuring optimal health outcomes and efficient utilization of health services in a remote setting.

Key responsibilities:

• Provide case management services, including pre-certification and assessments to evaluate treatment appropriateness
• Coordinate with primary care providers and other medical professionals to manage treatments and resources effectively
• Document all interactions and determinations in compliance with established standards and guidelines

Required qualifications:

• New York State RN or Licensed Social Worker (LCSW/LMSW) license
• Minimum of 3 years of experience in a mental/behavioral health or addictions setting
• Experience in managed care and case management
• Knowledge of InterQual and/or Milliman criteria
• Demonstrated ability to manage large caseloads effectively in a fast-paced environment