Hospital to Home Case Manager

Company: Capital District Physicians Health Plan Inc
Location: Albany
Posted on: April 1, 2025

Job Description:

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. 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 Hospital to Home Case 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 review, identifying barriers to care, care planning and collaboration with providers. Case 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 Hospital to Home Case 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 Hospital to Home Case Manager role is may be in a hospital facility or at CDPHP headquarters depending on program needs. They may be required to periodically meet with members in their home, physician office or community setting. This position is not a remote opportunity - it would be onsite between CDPHP offices and our health practice partners. Qualifications:

• 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, hospital 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 work collaboratively on a team.
• 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 pro-actively identify problems, as well as recommend and/or implement effective solutions.
• Demonstrated ability to interact with providers, members to positively impact the quality of patient care.
• Demonstrated ability to manage multiple projects in conjunction with a frequently changing patient caseload.
• Demonstrated ability to work with and maintain confidential information.
• Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
• Excellent verbal and written communication skills.
• Flexibility to adapt to a changing and fast-paced environment.
• 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.
• Annual Physical assessment, as well as any other clinical requirements, will be required by the designated facility.
• Spanish speaking preferred. CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay. CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at . As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of 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 Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.
  

Keywords: Capital District Physicians Health Plan Inc, Albany , Hospital to Home Case Manager, Healthcare , Albany, New York