New York RN Care Manager

Job Summary

To support efficient inpatient utilization management, the remote New York RN Care Manager will perform clinical reviews, ensure accurate benefit administration, and collaborate with care teams to evaluate member needs.

Key responsibilities

• Execute departmental processes for managing inpatient utilization within benefit plans
• Act as a clinical coordinator to collaborate with members and facilities for appropriate clinical reviews
• Communicate authorization decisions and benefit information to providers and members in compliance with regulations

Required qualifications

• Associate's degree or bachelor's degree in nursing
• Valid RN License without restriction
• 4 - 6+ years of nursing experience
• Experience in case management or utilization management preferred
• Certification in utilization or care management preferred