Case/Disease Management Specialist

The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits. This position will also assess, plan, implement and evaluate the options and services to meet an individual's health needs.


Acting as an advocate and liaison to meet a member’s individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services. This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits.  Exhibits and applies clinical understanding of the medical diagnosis(es), case/disease management processes, and psycho-social needs of members and their support system toward the development of an appropriate treatment plan in conjunction with the member’s physician(s) and other pertinent allied health professionals. Works collaboratively and communicates clearly and professionally with physicians, providers, co-workers and other members of the health care team in order to carry out the established plan of care. Demonstrates a thorough understanding of and applies the principles/standards of URAC and NCQA, Medical Services initiatives, and corporate group goals.
Identifies areas for potential cost savings, quality improvement and workflow efficiencies. Ability to work both as a team member and independently, demonstrating sound problem solving techniques.

Registered Professional Nurse with current New York State Licensure. Three (3) years clinical experience, two (2) of which must be in a hospital setting. Knowledge of utilization management, managed care, health insurance industry, and the provider community a plus.

Apply online at www.bsneny.com (Posting number 08-0185).