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Form of workJob Description
Seeking a Nurse with robust Pediatric Clinical Experience for Case Management Training.
For over 30 years, our health plan has prioritized strong connections with members and providers, fostering the healthiest lives for New Yorkers across the boroughs. Serving Bronx, Brooklyn, Manhattan, Queens, and Staten Island, we offer top-tier healthcare services through a diverse product range.
Children’s Nurse Care Manager – RN - Hybrid role (2-3 days Manhattan office, 2-3 days remote)
Salary up to $96,500+ with Outstanding Union Benefits (including Pension Plan)
Responsibilities:
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Company DescriptionFor over 30 years, our health plan has prioritized strong connections with members and providers, fostering the healthiest lives for New Yorkers across the boroughs. Serving Bronx, Brooklyn, Manhattan, Queens, and Staten Island, we offer top-tier healthcare services through a diverse product range.
Children’s Nurse Care Manager – RN - Hybrid role (2-3 days Manhattan office, 2-3 days remote)
Salary up to $96,500+ with Outstanding Union Benefits (including Pension Plan)
Responsibilities:
- Review and approve Plans of Care, CANS-NY assessments, and HCBS services.
- Authorize inpatient and DME for Medically Fragile and Care at Home children per UM requirements.
- Ensure proper access, level of care, and continuity for Medically Fragile and Care at Home children.
- Coordinate with Health Home Coordinators and Care Managers to meet patient treatment needs.
- Align member service needs with community agencies.
- Educate and coach members' families.
- Conduct quarterly assessment calls to Health Home Coordinators.
- Provide clinical guidance, support, and extensive knowledge of community resources/services.
- Participate in clinical rounds and liaise with Providers’ Clinical Teams for discharge planning.
- Perform telephonic care review and authorization determinations.
- Consult with Clinical Peer Reviewers for cases not meeting medical necessity criteria.
- Interact with stakeholders regarding medical benefits, triage, and crisis intervention.
- Bachelor’s Degree required.
- 2 years of clinical experience in an acute care setting.
- Experience using Interqual Guidelines.
- Knowledge of medical care and HCBS services for medically fragile children.
- Valid NYS RN license.
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RCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.
