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Proficient in project methodologies and quality testing programs.• Strong problem-solving skills and ability to adapt and respond to the diverse and unexpected situations normally encountered in marketing and service occupations.• Excellent oral and written communication skills and the ability to deal effectively and professionally with all levels of account management and personnel.• Ability to establish and maintain effective professional relationships.Level II (in addition to Level I Qualifications)• Five or more years of user experience in process management/improvement.• Demonstrated leadership, decision-making and team building skills.• Authoritative expertise with project design, system configuration design, development, creation of metrics, and governance processes required to manage projects.• Demonstrated ability to lead peers and project team members through challenging assignments.Physical Requirements:• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.************One Mission. One Vision. One I.D.E.A. One you.Together we can create a better I.D.E.A. for our communities.At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.OUR COMPANY CULTURE:Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.Equal Opportunity EmployerCompensation Range(s): Level I: Grade 207: Minimum $60,070- Maximum $111,114 Level II: Grade 208: Minimum $67,538 - Maximum $124,925The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Case Manager (RN) I/II/III - Commercial
Excellus Health Plan Inc., Rochester
Job Description: Summary: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.Essential Accountabilities:Level IHandles physical health member clinical management programs.Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable.Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,Maintains confidentiality and conducts information management procedures per corporate and departmental policy.Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews.Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services.Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals.Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena.Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits.Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment.Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources.Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory TherapistAccepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable.Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications.Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care.May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA).Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.May participate in the orientation of new staff.Regular and reliable attendance is expected and required.Performs other functions as assigned by management.Level II (in addition to Level I Essential Accountabilities)Handles all member clinical condition management programs.Offers process improvement suggestions and participates in the solutions of more complex issues/activities.Mentors junior staff and assists with coaching whenever necessary.Consistently meets/exceeds all productivity and performance metrics, including positive results of audits.Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health.Manages more complex assignments and/or larger caseloads.Displays leadership skills and serves as a positive role model to others in the department.Participates in the orientation of new staff.Level III (in addition to Level II Essential Accountabilities)Process Management and DocumentationIdentifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies.Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions.Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department.Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems.Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers.Provides backup for the Supervisor/Manager, whenever necessary by:Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care.Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing.Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group.Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities.Minimum Qualifications:NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.All LevelsAssociates 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) and benefits, 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.Level II (in addition to Level I Qualifications)A minimum of 2 years in case management position.Case Management Certification preferred.Delivers efficient, effective, and seamless care to members.Demonstrates ability to escalate to management, as necessary.Demonstrates proficiency in all related technology and documentation requirements.Consistently meets or exceeds all performance metrics.Level III (in addition to Level II Qualifications)Must have been in a current Case Management position or similar subject matter expert for at least 5 years.Case Management Certification requiredBroad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems.Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues.Ability to lead the training of new staff.Demonstrated presentation skills.Physical Requirements:Ability to travel and work long hours on a computer.May require flexible hours to meet needs of member discussions.************One Mission. One Vision. One I.D.E.A. One you.Together we can create a better I.D.E.A. for our communities.At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.OUR COMPANY CULTURE:Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.Equal Opportunity EmployerCompensation Range(s): Level I: Grade 205: Minimum $58,500 - Maximum $81,702 Level II: Grade 206: Minimum $58,500 - Maximum $93,267 Level III: Grade 207: Minimum $60,070 - Maximum $111,114The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Master Plumber
Service Experts, Rochester
Location: Rochester, NHPosition Title: Master Plumber Reports To: General ManagerStatus: Full-time, Regular position Location Name: StrogensAddress: 38 Milton Road, Rochester, NH 03868Join the team of experts and realize your true potential! Why You Should Join the Service Experts Team? Our team consists of the very best; we believe in doing what is right for our customers and our employees. We provide our employees with the training, support and an opportunity for unlimited professional growth. Join us and become an EXPERT! Position Summary: Under minimal supervision, performs diagnostic, service, and installation of plumbing in residential and light-commercial environments. Holds master plumbing and/or gas license as required by governmental regulations. Ensures that work is performed in accordance with relevant codes. Assembles, installs, or repairs pipes, fittings, or fixtures of heating, water, or drainage systems in accordance to specifications and plumbing codes. Communicates with customer to answer questions, resolves problems, and ensures complete customer satisfaction. Promotes products and services to customer. Works under the direction of the Field Supervisor or General Manager. What Do We Offer You as a Service Experts Employee? Service Experts offers a comprehensive benefits package designed to support employees and their families in managing their health and wellness needs. Following is a summary of the many benefits that could be available to you as a Service Experts valued employee. Competitive Pay, including incentive opportunities for many positions Paid Time Off and Company Holiday Pay Medical /Dental /Vision Insurance programs401(k) Retirement Savings Plan with company matching contributionsLife Insurance, for you and options you can elect for your familyShort-term and Long-term disability insurance options, that protects you and your family if you are unable to workSupplemental benefit programs such as: Legal advice, pet insurance, health advocacy programsWorld Class Training opportunities through our Experts UniversityCareer Development opportunities Key Responsibilities:Analyzes, diagnoses, and resolves customer problems in a courteous, professional, timely, and accurate manner. Identifies potential problems to prevent premature and unexpected breakdowns or callbacks. Maintains and repairs plumbing systems carrying water, steam, chemicals and fuel in heating, cooling, lubricating and other process piping systems by replacing defective washers, replacing or mending broken pipes, or opening clogged drains. Repairs or replaces plumbing fixtures; test joints and pipe systems for leaks, open clogged drains, measure, cut, thread, bend, ream and install pipe and pipe fittings. Inspects high pressure, air, steam, water and gas systems to ascertain malfunctions. Assembles pipe sections, tubing, or fittings, using couplings, clamps, screws, bolts, cement, plastic solvent, caulking, or soldering, brazing, or welding equipment. Weld small pipes or special piping, using specialized techniques, equipment, or materials, such as computer-assisted welding or microchip fabrication. Locates and marks the position of pipe installations, connections, passage holes, or fixtures in structures, using measuring instruments such as rulers or levels, and cuts openings Installs pipe assemblies, fittings, valves, appliances such as dishwashers or water heaters, or fixtures such as sinks or toilets, using hand or power tools. Anchors steel supports from ceiling joists to hold pipes in place. Cuts openings in structures to accommodate pipes or pipe fittings, using hand or power tools. Measures, cuts, threads, or bends pipe to required angle, using hand or power tools or machines such as pipe cutters, pipe-threading machines, or pipe-bending machines Installs underground storm, sanitary, or water piping systems, extending piping as needed to connect fixtures and plumbing Reviews blueprints, building codes, or specifications to determine work details or procedures. Interprets drawings and specifications to determine layout requirements. Studies building plans and inspect structures to assess material and equipment needs, to establish the sequence of pipe installations, and to plan installation around obstructions such as electrical wiring. Fills pipes or plumbing fixtures with water or air and observe pressure gauges to detect and locate leaks Directs helpers engaged in pipe cutting, preassembly, or installation of plumbing systems or components Ensures company property, vehicles, and tools are being used, maintained and properly accounted for Maintains current plumbing and/or gas license in accordance with governmental regulations Following standard procedures and process, ensures that the company vehicle is properly stocked, returns defective warranty parts to branch, and orders/replenishes vehicle stock as needed Represents the company professionally, honestly, and ethically in all business matters and activities Performs similar/other duties as needed or assigned Qualifications:High school diploma or equivalent with on-the-job and formal classroom training in plumbing work in construction, maintenance, commercial, and residential environments Seven years' experience in plumbing repair, maintenance, and installation in addition to on-the-job training Plumbing and/or gas license as required by local, state, provincial, or national governmental regulations EPA and safety certifications required Current knowledge of and continuing education in national, state, and local plumbing code regulations Proficient mechanical aptitude and the ability to operate all necessary tools and equipment to perform various plumbing projects Knowledge of machines and tools used in the construction or repair of houses, buildings and other structures. This knowledge includes the machine and tools design, uses, repairs, and maintenance. Working proficiency in basic mathematics and metric and standard measurements Proficient at reading wiring diagrams and troubleshooting problems with plumbing systems and equipment Effective communication skills to communicate with customer and resolve customer issues, complaints, or concerns Effective and efficient time-management and organizational skills Familiar with the HVAC industry is preferred Must be willing to train new plumbers in technical skills and company procedures Valid driver's license with acceptable driving record Available to work flexible hours and on-call shifts as needed Ability to stand and walk and to climb ladders and attic stairs and to maneuver in attics, basements, and crawl spaces. Ability to continually climb, balance, stoop, kneel, crouch, and/or crawl. Ability to work in a variety of environmental conditions, including but not limited to the following: hot, cold, outdoor, indoor, dry, humid, slippery surfaces, heights, and congested areas Ability to safely climb 300lb load capacity rated ladders Natural or corrected vision to see and focus for close, distance, peripheral vision with normal depth perception Ability to lift up to 100 pounds with assistance and ability to lift and carry items weighing up to 50
Treasury Reconciliation Analyst I/II
Excellus Health Plan Inc., Rochester
Job Description: Summary:The Reconciliation Analyst is responsible for analysis of premium billing/claims receivables and reporting used to monitor and measure business activity within the limits of established practices, policies and procedures. This position is accountable for analyzing operational activities related to premium billing/claims receivables, and for addressing any discrepancies between premium/claims billing and payment. In addition, this position creates models and makes recommendations for procedure changes based on analysis completed.Essential Accountabilities:All Levels• Prepares regular and periodic reports for the review and guidance of management, including the operations reporting of all transactions which include transaction analysis and recommendations.• Investigates, works, analyzes, tracks and monitors operational issues identified during the financial balancing activities and initiates necessary requests of other operational areas to solve identified problems or recommendations for future initiatives.• Performs assigned basic financial analysis (e.g., A/R, group/claims trends) and/or assists in financial analysis for supervisory review. Creates models and makes recommendations for procedure changes based on analysis completed.• Monitors, measures, and analyzes business activity within the limits of established practices, policies and procedures and makes necessary recommendations based on analysis.• As requested, performs special tasks and assignments and acts in the absence of the Manager.• Prepares documentation for all internal and external audit requests; participates in audit discussions.• Functions as operations department representative on assigned corporate teams involving project implementations and/or evaluation and improvement of operational practices.• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.• Regular and reliable attendance is expected and required.• Performs other functions as assigned by management.Level II - (in addition to Level I Accountabilities):• Defines requirements for improving existing processes and/or developing new processes relating to the Billing Reconciliation & Analysis department.• Collects and analyses division data which will be used to identify and resolve system problems that result in discrepancies in the financial balancing reports.• Participates as a Test Lead during projects and conversions for the department.• Serves as a subject matter expert for all reconciliation functions and processes.• Shares knowledge with newer department employees.Minimum Qualifications:NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.All Levels• HS Diploma/GED with 9 years' experience or Associate Degree with 6 years' experience, or Bachelor's Degree with 3 years' experience.• Expertise in financial modeling.• Strong analytical abilities.• Intermediate communication skills required.• Basic MS Excel and Cognos skills required.• Strong knowledge of MS Word, Access, and PowerPoint required• Relational database applications experience is required; intermediate database skills required.• Must possess a high degree of professionalism and be able to establish effective working relationships with all levels of the corporation.• May require periodic travel to other divisional offices.• Remains current on divisional procedures, policies and regulationsLevel II - (in addition to Level I Qualifications):• HS Diploma/GED with 10 years' experience or Associate Degree with 7 years' experience or a Bachelor's Degree with 4 years' experience.• Demonstrated expertise in statistical, project management, and analytical skills.• Intermediate MS Excel and Cognos skills required.Physical Requirements• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.************One Mission. One Vision. One I.D.E.A. One you.Together we can create a better I.D.E.A. for our communities.At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.OUR COMPANY CULTURE:Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.Equal Opportunity EmployerCompensation Range(s): Level I: Grade 110: Minimum $20.02- Maximum $33.03Level II: Grade 111: Minimum $21.83- Maximum $34.92The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Case Manager (RN) I/II/II - Safety Net
Univera HealthСare, Rochester
Job Description: Summary: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.Essential Accountabilities:Level IHandles physical health member clinical management programs.Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if managing members of Medicare programs, and other regulatory requirements as applicable.Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards, as well as licensure, certification and scope of practice requirements for each specific health-related field/specialty,Maintains confidentiality and conducts information management procedures per corporate and departmental policy.Implements the Case Management Process per department policies, procedures and guidelines. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews.Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources. Applies case management criteria and professional clinical judgment to determine a member's appropriateness for case management services.Initiates case management, as outlined in the Case Management Program Description. Opens appropriate cases timely and effectively. Using motivational interviewing, assures essential information relating to case management is disclosed to members, thus increasing the opportunity for success in meeting member health goals.Works in collaboration with members' physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary care plan, coordinates services, evaluates effectiveness of services and modifies the member care plan as necessary. Maintains positive working relationships within this arena.Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions to address knowledge deficits.Collaborates with member/caregiver to determine specific objectives, goals and actions to address member needs and barriers to meeting health goals identified during assessment.Provides appropriate resources and assistance to members with regards to managing their health across the continuum of care. Maintains updated information related to appropriate community resources and serves as a source of information for providers and other members of the healthcare team. Acts as a liaison between providers and community resources.Participates in inter-disciplinary coordination and collaboration to ensure delivery of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory TherapistAccepts responsibility for continuing education relative to professional growth. Meets or exceeds the minimum continuing education requirements as set forth by departmental and corporate policy, and by individual professional certification standards, if applicable.Participates in and promotes other health plan programs, such as, Preventive Health, use of web-based tools for self-management of conditions and engagement in digital health programs and applications.Work collaboratively with all Case Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and coordination of care.May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA).Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.May participate in the orientation of new staff.Regular and reliable attendance is expected and required.Performs other functions as assigned by management.Level II (in addition to Level I Essential Accountabilities)Handles all member clinical condition management programs.Offers process improvement suggestions and participates in the solutions of more complex issues/activities.Mentors junior staff and assists with coaching whenever necessary.Consistently meets/exceeds all productivity and performance metrics, including positive results of audits.Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health.Manages more complex assignments and/or larger caseloads.Displays leadership skills and serves as a positive role model to others in the department.Participates in the orientation of new staff.Level III (in addition to Level II Essential Accountabilities)Process Management and DocumentationIdentifies, recommends, and evaluates new processes as necessary to improve productivity and gain efficiencies.Assists in updating departmental policies, procedures and desk-top manuals relative to the CM functions.Identifies and develops processes and guidelines for performance improvement opportunities for the Case Management Department.Expert and resource for escalations. Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems.Mentors and provides guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and providers.Provides backup for the Supervisor/Manager, whenever necessary by:Participating in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care.Acting as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit (SIU), Provider Relations (PR), or Sales & Marketing.Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group.Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and educational needs to address established policies and procedures and job responsibilities.Minimum Qualifications:NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.All LevelsAssociates 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) and benefits, 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.Level II (in addition to Level I Qualifications)A minimum of 2 years in case management position.Case Management Certification preferred.Delivers efficient, effective, and seamless care to members.Demonstrates ability to escalate to management, as necessary.Demonstrates proficiency in all related technology and documentation requirements.Consistently meets or exceeds all performance metrics.Level III (in addition to Level II Qualifications)Must have been in a current Case Management position or similar subject matter expert for at least 5 years.Case Management Certification requiredBroad understanding of multiple areas (i.e. UM and CM). At this level, incumbent is required to know multiple functional areas and supporting systems.Expertise in Case Management area and able to handle complex assignments, challenging situations, and highly visible issues.Ability to lead the training of new staff.Demonstrated presentation skills.Physical Requirements:Ability to travel and work long hours on a computer.May require flexible hours to meet needs of member discussions.************One Mission. One Vision. One I.D.E.A. One you.Together we can create a better I.D.E.A. for our communities.At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees' experiences, skills, and perspectives, we take action toward greater health equity.We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.OUR COMPANY CULTURE:Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.Equal Opportunity EmployerCompensation Range(s): Level I: Grade 205: Minimum $58,500 - Maximum $81,702 Level II: Grade 206: Minimum $58,500 - Maximum $93,267 Level III: Grade 207: Minimum $60,070 - Maximum $111,114The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.