Healthfirst Care Manager, RN - Complex Care Telecommuter in New York, New York


Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area. Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable Position Summary: The Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of the member’s health care services. Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.



  • Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.

  • Conducts assessments to identify barriers and opportunities for intervention.

  • Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals.

  • Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.

  • Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly.

  • Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes.

  • Assists in identifying opportunities for alternative care options based on member needs and assessments.

  • Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan.

  • Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.

  • Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.

  • Occasional overtime as necessary.

  • Additional duties as assigned.


Minimum Qualifications:

  • Diploma, Associate's, or Bachelor's nursing degree with NY State RN License and related behavioral health clinical/case management experience;

Preferred Qualifications:

  • Fluency in Spanish, Korean, Mandarin, or Cantonese.

  • Knowledge of Interqual and/or LOCADTR.

  • Knowledge and experience with current community health practices for the frail adult population and cognitive impaired seniors.

  • Experience managing member information in a shared network environment using paperless database modules and archival systems.

  • Experience and knowledge of the relevant product line.

  • Relevant work experience preferably as a Care Manager.

  • Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.

  • Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems.

  • Experience using Microsoft Excel with the ability to edit, search, sort, filter, and other Microsoft and PHI systems.

  • Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.

Requisition ID 2017-15153

Job Locations US-NY-New York

Department Name Medicaid/Commercial Care Management

Equal Opp Statement -

Healthfirst is an Equal Opportunity Employer and does not discriminated against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.

Reasonable accommodation statement -

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 1-800-401-6000. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.