RN Case Manager: Collaborative Care & Outcomes

Capital District Physicians Health Plan Inc; Buffalo (NY); On-site; USD 62,000 - 118,000; Full time

Job summary

Capital District Physicians Health Plan Inc. seeks an experienced Case Manager to conduct, coordinate, and monitor member care in alignment with CMSA/NCQA standards.

The role involves collaborating with providers, educating members, and implementing comprehensive care plans to improve health outcomes and control costs. Multiple levels require licensure, three years of clinical experience, and strong communication.

Qualifications

• Associates degree required.
• Bachelor's degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required.
• Minimum of three years of clinical experience required.
• Proficiency with the Microsoft Office Suite required.
• Experience interpreting managed care benefit plans and knowledge of Medicare/Medicaid contracts preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently daily.

Responsibilities

• Handle Level I case management programs and maintain CMSA/NCQA standards knowledge.
• Collaborate with care teams to develop interdisciplinary care plans.
• Identify opportunities to educate, support, and coordinate care for members.
• Coordinate with providers and community resources to optimize outcomes.
• Ensure compliance with NYS DOH, CMS, and NCQA regulations.
• Mentor junior staff and support process improvements.
• Support value-based payment programs and productivity metrics.

Skills

Case management

Multitask

Verbal communication

Microsoft Office Suite

Understanding CMS/NCQA standards

Health plans knowledge

Education

Associates degree

Bachelor's degree preferred

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc. seeks an experienced Case Manager to conduct, coordinate, and monitor member care in alignment with CMSA/NCQA standards.

The role involves collaborating with providers, educating members, and implementing comprehensive care plans to improve health outcomes and control costs. Multiple levels require licensure, three years of clinical experience, and strong communication.