Enterprise Solutions Inc. · 13 hours ago
RN Care Manager - DH
White Plains, NY
Full-time
Onsite
Mid, Senior Level
$126K/yr - $160K/yr
3+ years expEnterprise Solutions Inc. is seeking an experienced Registered Nurse (RN) Care Manager to join a high-performing acute care hospital case management team. The RN Care Manager will conduct comprehensive patient assessments, coordinate multidisciplinary care, and ensure effective discharge planning to support optimal patient outcomes.
Information Technology & Services
Responsibilities
Perform comprehensive initial and ongoing patient assessments
Identify high-risk patients using established screening tools
Coordinate multidisciplinary care at intra-hospital and inter-hospital levels
Lead discharge planning and transitional care activities
Provide patient and caregiver education
Arrange post-acute services, home care, DME, and follow-up care
Collaborate with commercial payers and insurance providers
Conduct utilization review (UR) activities per department policy
Perform payer reviews, admission clinical reviews, retro/self-audits
Apply Milliman / InterQual criteria for medical necessity
Support denial prevention and appeals processes
Evaluate high-utilizer patient root causes
Ensure compliance with healthcare regulations and documentation standards
Participate in performance improvement and quality initiatives
Communicate effectively with physicians, nurses, social work, and care teams
Maintain accurate and timely electronic documentation
Support safe discharge planning for geriatric, medical, surgical, and ED patients
Perform additional duties as assigned
Qualification
Required
Registered Nurse (RN) – Active New York State License
BSN required (or MSN)
PRI Certification (must be obtained within 3 months of hire)
Strong clinical assessment and care coordination skills
Excellent communication, documentation, and computer skills
Ability to collaborate across multidisciplinary teams
Preferred
3+ years of clinical experience (ED, Critical Care, or Med-Surg)
Prior Case Management or Care Management experience
Care Management Certification (CCM, CMC, or similar)
Screen Certification
Knowledge of healthcare reimbursement, payer guidelines, and utilization management
Familiarity with state, local, and federal healthcare programs
Experience using InterQual / Milliman criteria
Understanding of LOS management, readmission reduction, and denial prevention
Benefits
Health, dental, and vision insurance
Retirement and savings plans
Paid time off and holidays
Continuing education support
Career advancement opportunities
Stable, mission-driven healthcare environment
Company
Enterprise Solutions Inc.
Enterprise Solutions, Inc. is a technology-intensive services company.
501-1000 employees
H1B Sponsorship
Enterprise Solutions Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (4)
2023 (1)
2022 (2)
2021 (3)
2020 (9)
Funding
Current Stage
Late StageCompany data provided by crunchbase