CARE MANAGEMENT ANALYST CMO

Yonkers, New York • Grant Funded • NCM - Central Intake Unit • Monday–Friday, 8:30 AM–5 PM (7.5 hours daily)

About the role

Under the supervision of a licensed or certified clinical professional, the Care Management Analyst (CMA) supports the operational functions of care management programs—including complex care, chronic care, palliative care, and care transitions. The CMA coordinates and manages key care management processes to ensure members receive timely, appropriate, and cost-effective healthcare services while adhering to organizational policies, regulatory requirements, and payer guidelines.

Responsibilities

• Coordinate operational activities supporting complex care, chronic care, palliative care, and care transitions programs.
• Process and manage medication prior authorizations through Pharmacy Benefit Managers (PBMs), health plans, and specialty pharmacies.
• Collect, review, and organize clinical and administrative information from members, caregivers, providers, and electronic health records.
• Evaluate benefit eligibility and utilization information in accordance with established policies, procedures, and clinical guidelines.
• Manage assigned care management processes and/or a designated caseload while ensuring timely follow-up and documentation.
• Collaborate with interdisciplinary care management teams to facilitate appropriate interventions and continuity of care.
• Serve as a resource to team members, physicians, providers, members, caregivers, and internal departments regarding care management processes.
• Maintain accurate documentation within care management and utilization management systems.
• Ensure compliance with organizational, regulatory, and payer requirements while maintaining confidentiality of member information.
• Support quality improvement initiatives and other departmental operational activities as assigned.

Requirements

• High School Diploma or GED required.
• Bachelor’s or master’s degree preferred (Nursing, Healthcare Administration, Public Health, or another health or human services field).
• Current LPN licensure and registration in NY State required.

Qualifications

• Experience processing medication prior authorizations with Pharmacy Benefit Managers (PBMs), health plans, or specialty pharmacies strongly preferred.
• Experience in medical management within a managed healthcare environment preferred.
• Previous case management, utilization management, care coordination, or population health experience preferred.
• Experience working with electronic health records (EHRs) and clinical documentation systems preferred.

Skills

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Experience with case management and utilization management software.
• Strong data entry and keyboarding skills.
• Familiarity with electronic health records (EHRs).
• Experience using electronic fax systems and automated call distribution systems.
• Ability to navigate web-based healthcare applications and databases.
• Experience operating standard office equipment, including scanners and copiers.
• Strong analytical and critical thinking skills.
• Excellent organizational and time management abilities.
• Effective written and verbal communication skills.
• Ability to prioritize multiple assignments in a fast-paced environment.
• Strong customer service and interpersonal skills.
• Ability to maintain confidentiality and exercise sound judgment.
• Ability to work collaboratively with interdisciplinary teams while managing multiple priorities.

Pay

$56,000.00–$70,000.00 per year