Summary Assist the Director in the coordination, implementation, monitoring and evaluation of quality and utilization activities related to outcomes management in accordance with CPHL, State and Federal mandates and regulations. Essential Functions Review hospital transfer cases (treat & release and admissions) w a written summary which will include care rendered the days leading up to transfer, determination of avoidable vs unavoidable with recommendations for improvement and discussion with assigned NPs. Review current POC for members identified as complex, i.e., uncontrolled HTN and DM, high risk for hospital readmission and members with high utilization cost and meet with assigned NPs as needed. Monthly clinical condition audits (CCIP) Telephone support for NPs Competencies Computer capabilities Familiarity with data analysis & utilization trending Excellent interpersonal skills, negotiation skills, presentation skills Excellent verbal and written skills Excellent training and audit skills Supervisory Responsibility Minimum of three years supervisory experience with a managed care or insurance company Work Environment This job operates in a professional environment. This role routinely uses standard equipment such as computers, phones, and photocopiers. Physical Demands This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand as necessary. Position Type and Expected Hours of Work This is a W-2 based position. Some travel to nursing facilities. Required Education and Experience Masters Level Prepared, Nurse Practitioner, preferably Geriatric Nurse Practitioner Knowledge and working experience with Medicare, Medicaid and state/federal health care regulations NYS Nurse Practitioner license 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.