New York Licensed Care Manager

Job Summary

A company is looking for a Care Manager, UM to support quality of care and cost containment through utilization management.

Key Responsibilities

• Conduct medical appropriateness evaluations for hospital admissions and outpatient procedures
• Coordinate care and assess member needs while ensuring compliance with regulatory guidelines
• Prepare clinical details for case determination and identify opportunities for cost reduction

Required Qualifications

• Associate Degree in Nursing; Bachelor's preferred
• Active, unrestricted RN or LPN nursing license
• 6+ years of clinical experience, including managed care and care management
• MCG Certification preferred
• Ability to work weekends and holidays on a rotating schedule