Senior Case Manager

Arlo•New York, NY

9d•$100,000 - $130,000

About The Position

We're hiring our first Senior Case Manager to own the medical journeys of our members. You'll review claims data, prior authorizations, and admission/discharge feeds to spot members who need help, then work directly with them and their providers to make sure the right care happens at the right time. This is a role for an experienced RN who can think clinically, communicate warmly, and operate independently - equal parts clinical judgment and hands-on coordination. You'll be a foundational member of our clinical team, with real influence over how we build our case management program from the ground up.

Requirements

Active, unrestricted RN license; multi-state compact license strongly preferred
5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning
Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation
Strong communication skills — you can hold your own with a skeptical specialist and also meet a member where they are
Self-directed; you can run your panel without someone over your shoulder
Comfort working in a fast-moving environment where processes are still being built

Responsibilities

Review claims, prior auth requests, and ADT (admission/discharge/transfer) data to identify members who would benefit from case management
Conduct clinical assessments and build individualized care plans with members
Coordinate directly with PCPs, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed
Support members through complex episodes — new diagnoses, hospitalizations, transitions of care, and chronic condition management
Partner with our utilization management workflows on medical necessity questions and appropriate level of care
Help us build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well
Document thoroughly and maintain compliance with applicable regulatory and accreditation standards