Local Contract Nurse RN - Long Term Care
Newyork, NY
Apidel Technologies
5x7 hrs, Days
Referral Bonus

Job Title: RN Care Manager – MLTC / MAP Program
Department: Managed Long Term Care (MLTC)
Location: New York
Schedule: Full-Time

Position Overview:
The RN Care Manager is responsible for coordinating and managing care for members enrolled in the Managed Long Term Care (MLTC) and MAP programs. The Care Manager collaborates closely with members, caregivers, primary care physicians, interdisciplinary teams, and community providers to develop and monitor individualized care plans that support quality outcomes, continuity of care, and independent community living.

Key Responsibilities:
• Review UAS assessments, clinical evaluations, and member health information to identify care needs, risk factors, and service requirements
• Develop, implement, and monitor individualized care plans in collaboration with members, caregivers, PCPs, and interdisciplinary teams
• Coordinate long-term care services including home care, transportation, DME, community resources, and specialty services
• Conduct monthly telephonic and/or face-to-face member follow-ups to monitor health status, service utilization, and care plan effectiveness
• Identify and address clinical concerns to reduce unnecessary hospitalizations, emergency room visits, and nursing home admissions
• Collaborate with Utilization Management, providers, discharge planners, and external agencies to ensure continuity of care across the healthcare continuum
• Review and process service authorization requests in accordance with clinical guidelines and regulatory requirements
• Maintain accurate and timely documentation of care coordination activities, assessments, and member interactions within required timeframes
• Participate in interdisciplinary care planning meetings and quality improvement initiatives
• Assist with grievance resolution, member concerns, and coordination of appeals documentation when needed
• Educate members and caregivers regarding available services, preventive care, chronic disease management, and community resources
• Ensure compliance with all Federal, State, MLTC/MAP, and organizational regulatory requirements

Qualifications:
• Bachelor’s Degree in Nursing (BSN preferred)
• Active New York State Registered Nurse (RN) License required
• Minimum 2–3 years of clinical experience in MLTC, MAP, Certified Home Health Agency (CHHA), home care, case management, or care coordination
• Strong knowledge of Medicaid, long-term care services, care planning, and community-based healthcare programs
• Experience with UAS assessments, care management systems, and electronic medical records preferred
• Excellent communication, critical thinking, organizational, and customer service skills

Preferred Experience:
• Managed Care or Health Plan experience
• Experience coordinating care for elderly or chronically ill populations
• Knowledge of utilization management and discharge planning processes

Core Competencies:
• Care Coordination
• Clinical Assessment & Care Planning
• Member Advocacy
• Regulatory Compliance
• Interdisciplinary Collaboration
• Time Management & Documentation
• Customer Service & Communication