Clinical Case Manager-Hybrid

The Clinical Manager provides clinical leadership, oversight, and operational support within the Personal Care department. This role serves as a key clinical resource supporting authorization review, care coordination, documentation compliance, staff supervision, and patient escalation management across managed care, MLTC, private pay, and skilled cases.

This leader partners closely with field staff, internal departments, payors, providers, and care managers to ensure safe, compliant, and timely delivery of services.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

• Provide clinical guidance to the Authorization/Denials unit and resolve escalations.

• Review Start of Care (SOC) and ongoing authorizations for accuracy and appropriateness.

• Provide daily clinical triage support and participate in rotating weekend on-call coverage.

• Supervise and support 3-6 full-time Registered Nurse Field Supervisors (RNFS) and per diem staff.

• Lead onboarding, orientation, shadowing, and role-based training.

• Provide ongoing supervision related to assessments, documentation, patient care, and regulatory compliance.

• Review clinical documentation to ensure alignment across assessments, POCs, PPOCs, 485s, and visit notes.

• Investigate documentation discrepancies and ensure timely resolution.

• Monitor reports to identify gaps in Plans of Care and coordinate corrective action.

• Partner with Quality Assurance on audits, chart reviews, and quality improvement initiatives.

• Coordinate care with providers, payors, care managers, and internal teams.

• Conduct member and caregiver outreach to resolve complaints, clinical concerns, and service issues.

• Serve as a clinical escalation point for complex cases.

• Provide ongoing clinical education to RNFS, field staff, and Home Health Aides.

• Complete monthly RN education reporting and participate in case conferences and interviews.

• Support payroll, PTO tracking, onboarding, and training logistics.

• Oversee private pay and skilled case readiness, ensuring proper orders and coordination prior to service initiation.

• Hybrid role:

  • 2 days required on-site in office

  • 3 days remote

• Schedule subject to change

• Current NYS Registered Professional Nurse (RN) license required

• Associate's Degree in Nursing required; Bachelor's Degree preferred

• Minimum 3 years of professional nursing experience

• Home care, case management, or supervisory experience preferred

• Strong clinical judgment, leadership, and communication skills

• Proficiency in HHAX and Microsoft Office

• Ability to manage multiple priorities and clinical escalations