A leading national Managed Care Organization is seeking a Case Manager for their location in New York.

Remote employees must live in New York Tri-state region

REQUIRED SKILLS AND QUALIFICATIONS

Education:

• Registered Nursing Degree required; Bachelor’s Degree in Nursing preferred; Case Management Certificate preferred.

Experience:

• Minimum of 2 years of Medical Case Management experience.
• Minimum of 1 year of Public Health experience.
• Minimum of 2 years of critical care and/or med-surg experience.
• Knowledge of applicable state, federal, and third-party regulations and standards (Background in discharge planning and home health).

Special Skills or Knowledge:

• Knowledge of a variety of clinical areas of medical treatment.
• Familiarity with hospital/patient care facilities, current practices, procedures, acceptable medical treatment, and diagnoses.
• Ability to learn company policies and procedures related to hospital authorization/denials, physician review, appeals, etc.
• Ability to apply established guidelines and regulations to specific and individual situations.
• Strong oral and written communication skills to ensure accurate transfer of information and build rapport.
• Proficiency in establishing and maintaining a variety of records necessary for providing complete information and documentation for relevant medical determinations.
• Ability to establish and maintain effective work relationships with various stakeholders.
• Proficiency with PC-based computer systems and ability to learn new information systems and software.
• Excellent organizational skills.

Licensure/Certification:

• Valid New York State Registered Nursing license (BSN preferred).
• Capability of transporting self to various locations. If operating a motor vehicle, must have a valid New York Driver’s license; if using own vehicle, must have proof of insurance coverage that at least meets current State minimum requirements.
• Certified Case Manager (CCM) Certification preferred.

This is an open-ended assignment and a great opportunity to join a national organization.