Nurse Care Manager - MLTC
$100k - $135k+ Performance-based bonus
Mid
Bachelor's, Associate's
Queens, NY, USA
In PersonRegular travel to homes, offices, and other public settings is essential; must reside in the assigned territory. Travel may exceed 50%.
Medical, Clinical & Veterinary
About the job
Requirements
- An associate degree in Nursing from an accredited nursing program is required.
- Two years of experience as a registered nurse are required.
- Current, unrestricted Registered Nurse licensure in New York is required.
- A valid driver's license, vehicle, and verifiable insurance are required; employment is conditional on successfully clearing a driver's license record check.
- Annual proof of influenza vaccination is required for designated positions during influenza season as a condition of continued employment.
- Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel.
- Knowledge of local, state, and federal healthcare laws and regulations, and company policies regarding case management practices.
- Adherence to the professional code of ethics.
- Knowledge of and adherence to Case Management Society of America standards for case management practice.
- Ability to interpret and implement current research findings.
- Awareness of community and state support resources.
- Strong advocacy for members at all levels of care.
- Understanding and sensitivity to cultural and demographic diversity.
- Critical listening and thinking skills.
- Decision-making and problem-solving skills.
- Strong organizational and time-management skills.
Responsibilities
- Provide care coordination, including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services, to meet members' health needs and promote quality, cost-effective outcomes.
- Assess and closely monitor members' needs and status to ensure consistent care across the healthcare continuum.
- Authorize covered services and coordinate care regardless of payer.
- Collaborate and communicate with members, families, caregivers, primary care practitioners, and the interdisciplinary team.
- Work with members and families to maintain the most independent living situation possible.
- Assess, plan, and provide continuous care management across hospital, sub-acute, long-term, and home settings.
- Regularly assess members' ongoing eligibility for services based on the applicable plan's eligibility criteria.
- Perform home visits as required to assess members' living situations, cultural influences, functional needs, and cognitive needs.
- Collaborate with the primary care physician and Inter-Disciplinary Team to develop each member's Patient Centered Service Plan.
- Ensure an appropriate and safe discharge plan for members leaving their plan.
- Identify same-day grievances, investigate and document them according to plan policy.
- Present members with complex care management needs or difficult-to-manage situations at Intensive Care Management meetings.
- Respond to members' requests within designated timeframes and complete Initial Adverse Determinations as indicated.
- Identify members requiring Care Management Review, evaluate documentation from the Inter-Disciplinary Team, including hospital or nursing-home discharge planners, and formulate an appropriate plan of care.
- Document care management and coordination according to company policy and the specific member plan, including monthly telephonic and in-person recertification notes where applicable.
- Develop efficient plans of care, authorize only needed services at appropriate levels, use network providers, and ensure services are based on members' needs.
- Perform other job-related duties as requested.
- Travel routinely to different work locations, including homes, offices, and other public settings, and travel more than 50% of the time when required.
- Reside in the assigned territory, subject to exceptions based on business need.
- Work flexible hours, including evenings or weekends as needed to serve members.
- Use general office equipment, including a telephone, photocopier, fax machine, and computer.
Desired Qualifications
- A bachelor's degree in Nursing.
- Clinical experience in geriatrics and/or managed long-term care.
- Case Management Certification.
- Bilingual speaking and writing skills.
About the company
CareSource provides health coverage to more than 2 million members, offering Marketplace plans as well as Medicare and Medicaid products. Its core service is delivering health insurance and related care to individuals and communities through a member-first approach, aiming to improve health and well-being over time. The company operates with a focus on affordable, accessible coverage and care coordination across states, guided by its mission to place people over profits rather than simply selling plans. Key differentiators include a long history (30+ years), a national footprint with 4,500+ employees, and an emphasis on serving members’ needs and languages while promoting equal opportunity employment. The overarching goal is to help members live healthier lives by providing comprehensive coverage and support.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Dayton, Ohio
Founded
1989
Get referred to CareSource
See people who can refer or advise you
Simplify's Take
What believers are saying
- CareSource launched the Atlanta-Tampa TRICARE Prime Demo with Telemynd in July 2026.
- Dr. Tamika Lasege joined Georgia on June 17, 2026, sharpening maternal and behavioral health.
- CCI affiliation closed April 1, 2026, expanding CareSource’s long-term-care footprint in Wisconsin.
What critics are saying
- Wisconsin OCI still scrutinized CCA control on March 12, 2026; integration delays invite backlash.
- CCA carried prior financial instability and regulatory scrutiny; any claims disruption damages CareSource credibility.
- Provider grievances and BBB complaints show service friction; a major eligibility or payment failure becomes existential.
What makes CareSource unique
- CareSource’s nonprofit Medicaid platform now spans Georgia, Massachusetts, Wisconsin, and TRICARE, unlike regional peers.
- Its family-of-brands model preserves local operations after acquisitions, including CCA on April 1, 2026.
- CareSource targets complex populations: Medicaid, dual-eligibles, older adults, disabilities, and military families.
Help us improve and share your feedback! Did you find this helpful?
Benefits
- Health Insurance
- Performance Bonus
- Flexible Work Hours