Member Health Policy Clinical Manager

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 Policy Clinical Manager will collaborate with the CDPHP team in the development, review and revision of CDPHP Resource Coordination policies, including internal and external distribution. This role will also assist in the evaluation of medical technologies and new uses of existing technologies for inclusion in CDPHP benefit plans. This will include researching new and emerging technologies and interfacing with the medical directors, utilization review staff, and other key policy stakeholders

Qualifications:

• Bachelor's degree or four (4) years of equivalent experience required.
• Registered Nurse or Nurse Practitioner with valid NYS registration or license required.
• Minimum two (2) years of utilization management concepts and techniques within an HMO, Managed Care Organization, Indemnity or related health care industry is required.
• Knowledge of CPT4 and HCPCS coding required.
• Knowledge of health plan regulatory and accreditation requirements required.
• Demonstrated ability to research and write medical policies.
• Must be detail-oriented with strong organizational skills, including the ability to coordinate workflow.
• Demonstrated ability to proactively 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.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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