Outpatient Care Manager at Capital District Physicians Health Plan Inc in Albany, New York

Posted in Management 5 days ago.





Job Description:


CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.


The Outpatient Care Manager (RN) is responsible and accountable for coordinating the care of CDPHP members who meet criteria for services across the continuum of care. Activities focus on the successful transition of care for CDPHP members who have been hospitalized and are being discharged, with a focus on readmission avoidance. Specific activities include member outreach, medication reconciliation, identifying barriers to care, care planning and collaboration with providers. Care Managers will also provide education and support to members who have ongoing chronic health needs, they will also serve as a resource to answer day-to-day clinical questions from members and other CDPHP business areas.

The Outpatient Care Manager will navigate a variety of applications and platforms in the daily administration of work. They must combine strong clinical knowledge and critical thinking to coordinate and support a care plan that will monitor quality medical care for the member population serviced by CDPHP.

The Outpatient Care Manager role is mostly telephonic in a managed care office setting. They may be required to periodically meet with members in their home, physician office or community setting.


QUALIFICATIONS:


  • Associates degree required. Bachelor's degree preferred.

  • Registered Nurse with a current New York State license is required.

  • Bachelor's degree in Nursing preferred.

  • Certified Case Manager (CCM) certification preferred.

  • PRI (Patient Review Instrument) certification preferred.

  • Minimum three (3) years clinical experience is required.

  • Experience with chronic condition management required, experience with diabetes and heart disease is preferred.

  • Case management experience preferred.

  • Experience working with health, social service and funding resources, including community agencies and alternate care delivery systems is preferred.

  • Experience in home care, medical office setting or managed health plan preferred.

  • Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required.

  • Demonstrated ability to provide case management for complicated members with multiple comorbidities and chronic diseases.

  • Demonstrated ability to communicate effectively with members with varying levels of education, health literacy and understanding.

  • Demonstrated ability to work with diverse population.

  • Ability to navigate system applications with accuracy.

  • Demonstrated ability to interact with providers, members to positively impact the quality of patient care.

  • Demonstrated ability to review health care delivery against established criteria.

  • Ability to travel to a variety of sites across CDPHP service area,during regular business hours, evenings and possibly weekends may be required.

  • Valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile required.

  • Spanish speaking preferred.



As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Solutions (PSS), and ConnectRX Services, LLC.