Utilization Review Nurse

Care Manager (RN) – Non-Patient-Facing - MLTC

Location: New York, NY - Hybrid

Schedule: Monday–Friday | 9:00 AM – 5:00 PM (35 hours/week)

Job Start date: 08/31/2026

Duration: 8–13+ weeks (extension possible)

Pay Rate: $60–$61/hour

We are seeking an experienced Registered Nurse (RN) for a non-patient-facing Care Manager position in New York. This role is focused on care coordination, utilization management, discharge planning, and case management. The RN will collaborate with interdisciplinary teams, members, and caregivers to develop and manage individualized care plans while ensuring appropriate utilization of healthcare services and improved member outcomes.

Responsibilities:

• Coordinate and manage member care plans.
• Perform utilization review and discharge planning.
• Collaborate with providers and interdisciplinary teams.
• Assess member needs and coordinate appropriate services.
• Maintain accurate documentation and ensure compliance with regulatory guidelines.
• Support quality improvement and care management initiatives.

Qualifications:

• Active New York RN License
• BSN required
• Minimum 5 years of clinical nursing experience
• Experience in Care Coordination, Utilization Review, and Discharge Planning
• MLTC experience required
• Computer proficiency required
• PRI and Screen Certification required within 3 months of hire

Benefits

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Employment Opportunity

Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.