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.
- 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