Registered Nurse Care Manager

CareSource

. Provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services .

Posted 10/6/2026full-timeBronx • New York • United StatesJuniorMid-Level💰 $100,000 - $135,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination, including in-home assessments, service authorization, and interdisciplinary collaboration to support independent living for members. Proficient in navigating healthcare laws and case management standards while ensuring effective care management across various settings.

Highest-signal resume keywords

Registered Nurse LicensureCare CoordinationCase Management CertificationHealthcare Laws and Regulations KnowledgeBilingual Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementPatient Centered Service PlansHome AssessmentsService AuthorizationDocumentation of Care ManagementEligibility AssessmentGrievance InvestigationFunctional Needs AssessmentCognitive Needs AssessmentClinical Experience in Geriatrics

Soft Skills

CollaborationAdvocacyCommunicationProblem SolvingFlexibility

Tools & Technologies

Microsoft OfficeGeneral Office Equipment

Certifications & Qualifications

Registered Nurse LicensureCase Management Certification

Industry Keywords

Healthcare ContinuumInterdisciplinary TeamCommunity Support ResourcesCMSA StandardsAdverse Determinations

About the role

Key responsibilities & impact

Provide care coordination, including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services
Assess and closely monitor members' needs and status across the healthcare continuum
Authorize covered services and coordinate care regardless of payer
Collaborate with members, families, caregivers, primary care practitioners and the interdisciplinary team
Support members in maintaining the most independent living situation possible
Provide continuous care management across hospital, sub-acute, long-term and home settings
Assess ongoing eligibility for services based on plan-specific criteria
Perform home visits to assess living situation, cultural influences, functional needs and cognitive needs
Collaborate with the primary care physician and Inter-Disciplinary Team to develop Patient Centered Service Plans
Ensure appropriate and safe member discharge plans
Identify, investigate and document same-day grievances
Present members with complex care management needs at Intensive Care Management meetings
Respond to member requests within designated timeframes and complete Initial Adverse Determinations as indicated
Identify members requiring Care Management Review and formulate appropriate plans of care
Document care management and coordination according to company and plan policies
Develop efficient plans of care and authorize needed services at appropriate levels using network providers
Perform other related duties as requested

Requirements

What you’ll need

Associate degree in Nursing from an accredited nursing program required
Two (2) years of experience as a registered nurse required
Current, unrestricted Registered Nurse licensure in the state of New York required
Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel
Knowledge of local, state and federal healthcare laws and regulations and company case management policies
Knowledge of and adherence to Case Management Society of America (CMSA) standards
Ability to interpret and implement current research findings
Awareness of community and state support resources
Valid driver's license, vehicle and verifiable insurance required
Successful clearance of a driver's license record check required
Influenza vaccination required, with annual proof during Influenza season
Must reside in the assigned territory
Ability to travel greater than 50% of the time
Ability to use general office equipment
Ability to work flexible hours, including possible evenings and weekends
Bachelor's degree in Nursing preferred
Clinical experience in geriatrics and/or managed long-term care preferred
Experience using multiple languages may be required based on operational needs
Bilingual speaking and writing skills preferred
Case Management Certification preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs
Annual Influenza vaccination requirement and verification during Influenza season
Flexible hours, including possible evenings and/or weekends as needed