Nurse Case Mgr II (US)

About the role

The Nurse Case Manager II performs care management for members with complex and chronic care needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize health across the continuum. The role is primarily virtual full‑time with occasional required in‑person training, and may involve on‑site duties such as hospital discharge planning. Candidates must reside within a reasonable commuting distance of a New York office unless an accommodation is granted.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develop a specific care management plan addressing objectives and goals.
• Implements the care plan by facilitating authorizations/referrals within benefits structure or through extra‑contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims, or service issues.
• Assists with the development of utilization and care management policies and procedures.
• Performs duties telephonically or on‑site (e.g., hospitals for discharge planning).

Requirements

• BA/BS in a health‑related field and minimum of 5 years of clinical experience; or any equivalent combination of education and experience.
• Current, unrestricted RN license in the applicable state(s).
• Multi‑state licensure if services are provided in multiple states.

Qualifications

• Certification as a Case Manager (preferred).
• BS in a health or human services‑related field (preferred).

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401(k) contribution.

Pay

The salary range for this position in New York is $79,464 to $119,196.

Schedule

Monday–Friday 8:00 am–4:30 pm, with 2–3 late evenings per month from 11:30 am–8:00 pm.