Case Manager, RN

LTHC

. Conduct case management program activities according to departmental, corporate, NYS DOH, CMS, FEP, and NCQA standards .

Posted 10/26/2026full-timeRochester • New York • United StatesMid-LevelSenior💰 $62,400 - $117,622 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management activities, including assessment, care planning, and interdisciplinary collaboration, while ensuring compliance with regulatory standards. Proficient in utilizing motivational interviewing techniques and managing complex cases to support member health goals.

Highest-signal resume keywords

Case Management CertificationActive NYS RN LicenseClinical ExperienceKnowledge of Medicare and MedicaidProficiency with Microsoft Office Suite

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data AnalysisCare Plan DevelopmentMotivational InterviewingOutcome MeasurementInterdisciplinary CoordinationProcess ImprovementDocumentation ComplianceManaged Care Benefit InterpretationPerformance Metrics ManagementBehavioral Health Experience

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationMultitasking AbilityIndependent WorkPresentation Skills

Certifications & Qualifications

Case Management CertificationNYS RN LicenseRegistered Dietician LicensePhysical Therapist License

Industry Keywords

NYS DOH StandardsCMS StandardsFEP StandardsNCQA StandardsValue-Based Payment ProgramsPreventive HealthDigital Health ProgramsUtilization ManagementQuality AssuranceCustomer Advocacy

About the role

Key responsibilities & impact

Conduct case management program activities according to departmental, corporate, NYS DOH, CMS, FEP, and NCQA standards
Identify members meeting case management criteria through data analysis and referrals
Assess members and determine appropriateness for case management services
Open and manage cases, conduct assessments, provide education and support, develop care plans, coordinate interventions, measure outcomes, and close cases
Use motivational interviewing to support members in meeting health goals
Collaborate with physicians, providers, caregivers, interdisciplinary teams, and community resources
Coordinate services and evaluate and modify member care plans
Educate members and caregivers about illnesses and health management
Provide resources and assistance across the continuum of care
Participate in interdisciplinary coordination with Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitians, and Respiratory Therapists
Promote preventive health, web-based self-management tools, and digital health programs
Support value-based payment programs such as accountable cost and quality arrangements
Maintain confidentiality, member privacy, documentation, regulatory compliance, and attendance standards
Participate in staff orientation and perform other assigned functions
Level II: mentor junior staff, manage complex assignments and larger caseloads, suggest process improvements, and support coaching
Level III: improve processes, update policies and manuals, serve as escalation subject matter expert, mentor clinical staff, provide supervisory backup, liaise with Customer Advocacy, Customer Service, SIU, Provider Relations, and Sales & Marketing, and audit regulatory compliance

Requirements

What you’ll need

Associate degree required; Bachelor’s degree preferred
Active NYS RN, Registered Dietician, or Physical Therapist licensure required
Minimum of three years of clinical experience required
Case Management experience preferred
Proficiency with Microsoft Office Suite
Experience interpreting managed care benefit plans preferred
Strong knowledge of Medicare and Medicaid government program contracts and benefits preferred
Strong written and verbal communication skills
Ability to multitask and balance priorities
Ability to work independently daily
Case Management Certification required within two years for FEP line-of-business incumbents
Hospital to Home incumbents: active NYS RN license with three years’ behavioral health experience, or LMSW, LCSW, or LMHC required
Level II: minimum of two years in a case management position; ability to escalate to management; proficiency in related technology and documentation; ability to meet performance metrics
Level III: at least five years in a current Case Management position or similar subject matter expert role; Case Management Certification required; broad understanding of UM and CM; expertise handling complex assignments; ability to lead training; demonstrated presentation skills
Ability to travel and work long hours on a computer
May require flexible hours to meet member discussion needs

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Opportunity for remote work on a case-by-case basis
Continuing education for professional growth
Potential participation in value-based payment programs