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Role Description

Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member’s case assignment.

• Uses a systematic approach to identify members meeting program criteria.
• Assesses for opportunities to educate, support, coach, coordinate care and review treatment options.
• Participates in a cross-functional, multi-disciplinary team to identify and implement member-centric interventions.
• Collaborates with interdisciplinary care team to develop a comprehensive care plan.

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; Case Management experience preferred.
• Must demonstrate proficiency with the Microsoft Office Suite.
• Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Must demonstrate ability to work independently on a daily basis.
• Deliver efficient, effective, and seamless care to members.

Requirements

• For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within three (3) years of either hire and/or moving into this role supporting the FEP LOB.

Benefits

• Compensation Range(s):
• Level I: Grade E2: Minimum $60,410 - Maximum $96,081
• Level II: Grade E3: Minimum $60,410 - Maximum $106,929
• Level III: Grade E4: Minimum $65,346 - Maximum $117,622
• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work and paid holidays.

Physical Requirements

• Ability to travel and work long hours on a computer.
• May require flexible hours to meet needs of member discussions.