[Hiring] Case Manager, RN or Licensed Behavioral Health (Pediatrics) @company

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; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.

Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member’s needs, health goals and mitigate health care cost drivers.

We are seeking a candidate with demonstrated experience working within the foster care system, including an understanding of the unique needs of children and families involved. This experience will be critical in supporting effective service delivery and fostering positive outcomes.

Qualifications

• Associates degree required. Bachelor’s degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required; or LMSW; or LCSW; or LMHC.
• 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 two (2) years of either hire and/or moving into this role supporting the FEP LOB.
• Level II: A minimum of 2 years in case management position. Case Management Certification preferred.
• Level III: Must have been in a current Case Management position or similar subject matter expert for at least 5 years. Case Management Certification required.

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Compensation Range(s)

• Level I: E2: Minimum: $62,400 - Maximum: $96,081
• Level II: E3: Minimum: $62,400 - Maximum: $106,929
• Level III: E4: Minimum: $65,346 - Maximum: $117,622