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.
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 - 30+ days ago
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