Qualifications/Responsibilities: Working with IPA providers, other members of the interdisciplinary care team and CMO medical directors and in accordance with regulatory and benefit coverage parameters, help determine and coordinate comprehensive care plans appropriate to the health care needs of IPA members, including but not limited to, inpatient hospitalization, outpatient services, professional services, home care, durable medical equipment and other ancillary services. Evenings and weekend hours maybe required. NYS licensed RN and current registration, BS Nursing or related field and 5 years of clinical experience or a combination thereof. Minimum of 2 years recent experience of utilization review or case management in a managed care organization required. Experience in the use of Med. Mgt/UM computer systems and the application of UM decision support criteria required. Experience in use of windows based software applications and data entry focus required. Excellent interpersonal and communication skills required. Commitment to interdisciplinary teamwork required. Experience in intergrating and applying benefit coverage rules and assesing coordination of benefits guidelines and managed care regulation requiered.