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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 BH Utilization Specialist is responsible for coordination of care for CDPHP members across the continuum, beginning with hospitalizations and focused on helping members who are hospitalized with behavioral health needs. This includes members admitted to psychiatric units, substance use disorder treatment facilities or hospital units, and general medical units. Activities focus on the seamless transition of care for CDPHP members through collaboration with the Outpatient Care Manager whose role it is to follow our member in the community after being discharged from an acute or subacute level of care. The BH Utilization Specialist will conduct telephonic care coordination activities with members, their loved ones and the hospital treatment team. This includes participation in treatment planning, discharge planning, and includes potential face to face interaction with members and other identified care givers for the purposes of assessing for social determinants of health (SDOH). This position requires awareness of medical necessity criteria and commercial/Medicaid/Medicare benefits and the ability to make recommendations for appropriate alternative services to the medical directors.

This position is remote with the potential for meetings on-site at CDPHP headquarters.

Qualifications:

+ Licensed Master Social Worker, Licensed Clinical Social Worker, or Licensed Mental Health Counselor (Valid New York State license is required)

+ In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience treating psychiatric and/or substance abuse patients is required.

+ Certified Case Manager (CCM) designation preferred.

+ PRI (Patient Review Instrument) certification preferred.

+ Minimum one (1) year of acute care experience in a hospital setting required.

+ Minimum one (1) year quality/utilization management experience in health care setting preferred.

+ Experience with utilization management software including Facets, Macess and ClinicalCareAdvance strongly preferred.

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

+ Demonstrated ability to develop rapport and anticipate a members needs through ongoing communication and coordination with families, hospitals, providers etc.

+ Demonstrated ability to work collaboratively with multiple partners to positively affect outcomes at the team, organization and member level.

+ Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.

+ Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.

+ Demonstrated ability to work with and maintain confidential information.

+ Excellent verbal and written communication skills.

+ Flexibility to adapt to a changing and fast-paced environment.

+ Ability to travel locally. Access to reliable transportation to all CDPHP service areas to deliver service to members during regular business hours, evenings and possible weekends is required. Position requires someone who is flexible on a day to day basis to travel to facilities in the Capital District.

+ Annual physical assessment will be required, as well as any other clinical requirements requested by the designated facility.

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 https://www.cdphp.com/about-us/jobs/benefits .

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.