Registered Nurse Case Manager
CDPHP - Albany, NY

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Responsible and accountable for coordinating the care of CDPHP members who meet case management criteria across the continuum of care; ensuring and facilitating the achievement of quality, clinical and cost outcomes through negotiating and coordination of benefits with third- party payors and employer groups to determine resources needed by the members and their families.

QUALIFICATIONS :
  • Registered Nurse (RN) with a current New York State license is required. Certified Case Manager (CCM) preferred.
  • Minimum 2 years clinical experience required.
  • Utilization management/case management experience preferred.
  • Demonstrated problem solving and organizational skills and ability to interact with providers and members to positively impact the quality of patient care required.
  • Demonstrated ability to review health care delivery against established criteria required.
  • Demonstrated PC skills experience required.
  • Working knowledge of health, social service and funding resources, including community agencies and alternate care delivery systems required.
  • Excellent verbal/written communication skills required.
  • Access to reliable transportation to all CDPHP service areas to deliver service to members during regular business hours, evenings and possibly weekends required.
  • Daily travel may be required within extended Capital District area, as far North as the Adirondacks and as far South as Hudson Valley.

Salary Grade: 16

CDPHP - 22 months ago - save job
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