RN Case Manager – Care Coordination & Outcomes

Capital District Physicians Health Plan Inc; City of Rochester (NY); On-site; USD 62,000 - 107,000; Full time

Job summary

Capital District Physicians Health Plan Inc is seeking a qualified Case Management professional to support CMSA/NCQA-aligned care programs in New York. The role focuses on identifying eligible members, coordinating services, educating members, and collaborating with providers to optimize outcomes.

You will work with an interdisciplinary team to develop comprehensive care plans, monitor progress, and ensure regulatory compliance.

Qualifications

• Associates degree required; bachelor’s preferred.
• Active NYS RN or other licensure required.
• Minimum of three years clinical experience; case management experience preferred.
• Proficient with Microsoft Office; CMS/NCQA knowledge beneficial.
• Experience interpreting managed care contracts (Medicare/Medicaid) preferred.

Responsibilities

• Identify and manage CMSA/NCQA compliant case management activities.
• Collaborate with physicians and care team to develop interdisciplinary care plans.
• Educate and support members to achieve health goals.
• Maintain confidentiality and comply with regulatory standards.
• Monitor and report member outcomes and program performance.
• Provide leadership and mentor junior staff as required.
• Contribute to process improvements and documentation.

Skills

RN licensure NYS

Dietitian licensure

Physical Therapist licensure

Case Management experience

Microsoft Office proficiency

Managed care knowledge

Interdisciplinary collaboration

Education

Associates degree required

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc is seeking a qualified Case Management professional to support CMSA/NCQA-aligned care programs in New York. The role focuses on identifying eligible members, coordinating services, educating members, and collaborating with providers to optimize outcomes.

You will work with an interdisciplinary team to develop comprehensive care plans, monitor progress, and ensure regulatory compliance.