New York Licensed Medical Case Manager

Job Summary

Providing comprehensive telephonic case management, the full-time New York Licensed Medical Case Manager will engage with injured employees, healthcare providers, and employers to facilitate medically appropriate returns to work while working remotely with potential hybrid office options.

Key responsibilities

• Utilizes clinical skills to assess the medical necessity of patient care and coordinates treatment programs for optimal quality and cost-effectiveness
• Conducts Utilization Review activities and maintains comprehensive documentation of case management activities
• Collaborates with claims adjusters and other stakeholders to develop medical resolution strategies and ensure appropriate care for injured employees

Required qualifications

• Active unrestricted New York RN license; New Jersey Compact license preferred
• Bachelor's degree in nursing (BSN) or equivalent work experience preferred
• Five years of related experience, including two years of direct clinical care or case management
• Certification in case management, pharmacy, rehabilitation nursing, or a related specialty is highly preferred
• Fluency in Spanish and English preferred