RN Case Manager: Care Coordination & Education

Capital District Physicians Health Plan Inc; City of Utica (NY); Remote; USD 62,000 - 118,000; Full time

Benefits offered by this job

Remote work potential

Job summary

Capital District Physicians Health Plan Inc is seeking a Case Management professional to execute program activities in alignment with CMSA/NCQA standards and NYS DOH guidelines. You will assess members, educate, coordinate care, and collaborate with providers to optimize outcomes.

The role involves cross-functional teamwork, identifying interventions, and maintaining privacy while advancing cost-effective care. Remote work may be possible on a case-by-case basis.

Qualifications

• Associates degree required; Bachelor's degree preferred.
• Active NYS RN license or Registered Dietitian or Physical Therapist license required.
• Minimum of three years of clinical experience; case management experience preferred.
• Proficiency with the Microsoft Office Suite.
• Experience interpreting government program contracts (Medicare/Medicaid) and benefits.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently daily.
• FEP certification required within two years where applicable.

Responsibilities

• Handles all member clinical condition management programs.
• Maintains knowledge of CMSA/NCQA standards and applicable regulations.
• Implements Case Management Process with case identification, assessment, education, and care planning.
• Collaborates with physicians and care teams to develop interdisciplinary care plans.
• Coordinates services and evaluates effectiveness of care.

Skills

Communication skills

Multitasking

Microsoft Office

Interpreting benefits

Education

Associates degree required

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc is seeking a Case Management professional to execute program activities in alignment with CMSA/NCQA standards and NYS DOH guidelines. You will assess members, educate, coordinate care, and collaborate with providers to optimize outcomes.

The role involves cross-functional teamwork, identifying interventions, and maintaining privacy while advancing cost-effective care. Remote work may be possible on a case-by-case basis.