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  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #255
    Thursday, August 22, 2019
    Status: Full-time, Exempt: Yes    The Integrated Health HARP Case Manager (IH-HARP CM) will work with all stakeholders to ensure that the HARP members healthcare needs are met.  Through a collaborate internal process with the Health Home Case Manager (HH CM), the IH- HARP CM will review Plans of Care, NYS Eligibility Assessments, and recommendation for services, including approval or denial of services as  appropriate.  The IH – HARP CM will oversee the authorizations of person centered, indiv ... More
  • Tarrytown Office
    Req #106
    Thursday, August 22, 2019
    Status: Fall Intern, Part time    Location: Tarrytown, NY        The intern will be responsible for assisting the Medicaid Strategic Business Unit with day-to-day activities to ensure organizational compliance with all Medicaid and Child Health Plus contract requirements and State, Federal and local rules and regulations. Provide departmental support to ensure SBU programs and projects meet organization goals and requirements Responsibilities include document ... More
  • Tarrytown Office
    Req #209
    Thursday, August 22, 2019
    Reviews and facilitates general quality overview and improvements in all areas of the Retail Outreach Sales Call Center and acts as support in training, employee development, and process improvements. Responsibilities include: Facilitates RO Sales Call Center Coaching (Call Quality Review) program. Includes oversight of staff and the applicable tasks including call monitoring & campaigns, coaching, standards implementation and review, quality training and feedback, performance tracking, and comm ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #257
    Wednesday, August 21, 2019
    Status: Full-time, Exempt: Yes     Job Summary  This position makes triage and referral decisions requiring clinical judgement. The individuals will follow members for mental health, substance abuse and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care.  The individual will review all requests for inpatient services in view of the Appropriate BH and MVP standards, such as Interqual and LOCADTR guidelines, assuring that appropriate follo ... More
  • Rochester Office; Syracuse Office
    Req #252
    Wednesday, August 21, 2019
    Status: Full-time, Non-Exempt Summary: Addressesphone calls regarding inquiries, questions, and concerns relating to memberFlexible Spending Accounts and Health Reimbursement Accounts.  Has a goodunderstanding of Flexible Spending Accounts (FSA’s), Health ReimbursementArrangements (HRA’s) and governing IRS Guidelines. Setup and maintain clientand participant account information within the Alegeus claims paymentsystem.  Supports processing of claims  disbursements, andweekly/monthly reporting.  P ... More
  • Rochester Office
    Req #251
    Wednesday, August 21, 2019
    Status: Full-time, Exempt: Yes This position will execute and maintain oversight of compliance-related projects/ programs, QC of appeal and complaint cases, and trending areas in need of education and providing that education for the Appeals Department. • Intake and QC of all Behavioral Health appeals, correspondence and complaints in absence of Intake Coordinator. • Provides direction, implementation support, and oversight for new and current departmental processes in support of opti ... More
  • Headquarters Office; Rochester Office
    Req #243
    Wednesday, August 21, 2019
        Status: Full-time, Exempt: Yes     Summary: This position will utilize the essentials of an integrated case management model that includes assessment, planning, implementation, care coordination, monitoring and advocacy to meet the member’s overall comprehensive health needs. Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, resources and healthcare c ... More
  • Headquarters Office
    Req #239
    Wednesday, August 21, 2019
    Professional, Sales Trainer   Summary We are looking for a Sales training specialist to coordinate and support our sales team. The Sales Trainer’s responsibilities include conducting skills gap analyses, preparing training material and evaluating results after each training session. For this role, you will work closely with our sales teams to identify challenges they face on-the-job and recommend ways to increase productivity. You’ll also be responsible for ensuring new employees receive onboard ... More
  • Headquarters Office
    Req #223
    Wednesday, August 21, 2019
    Status: Full-time, Non-Exempt           Summary: Primarily responsible for the entry, management, verification and reporting of the MVP participating and non-participating provider data, with the objective of keeping all information relating to these providers accurate and up to date enabling accurate and timely payment of claims, accurate marketing and reporting, and effective recruitment of physicians. This includes daily data entry or updating of information in Cactus and/or Facets ... More
  • Rochester Office; Rochester, NY, US
    Req #108
    Wednesday, August 21, 2019
    Status: Part Time (20 hours per week) Location: Rochester, NY   Commercial Health Promotion Intern -   Rochester MVP’s Commercial Health Promotion Team assists employer groups to develop worksite well-being programs. The program intern would help support a number projects to assist employees and their families to develop and maintain optimum well-being. In addition the intern will support development and implementation of well-being programs offered in ... More
  • Headquarters Office; Rochester Office
    Req #70
    Tuesday, August 20, 2019
    Professional, Claims Operations Team Lead  Summary: This role will be responsible for ensuring great member and provider experience by leading multiple projects and initiatives, concentrating on putting our customers at the center of how Operations operates. Responsibility for oversight on all projects including direction, coordination, implementation, execution, controls, and completion, while remaining aligned with the strategy and values of the organization and ensuring all proj ... More
  • Fishkill Office
    Req #253
    Tuesday, August 20, 2019
    Associate, Retail Outreach ReceptionistSummary: Responsible for day-to-day operation of the reception area ensuring the representation of MVP Health Care in a professional manner through telephone and direct contacts with all customers and employees. Greet and announce visitors. Provide support as needed. Performs other duties as assigned. POSITION QUALIFICATIONS Minimum Education: High school diploma or equivalent with a minimum of 6-month work experience in a reception ... More
  • Schenectady, NY, US
    Req #206
    Tuesday, August 20, 2019
     Summary:Provides customer service on a wide range of technical issues to internal MVP employees and external constituents in busy call center environment. Works scheduled phone support shifts comprising a significant portion of the workweek. Resets passwords and troubleshoots basic desktop PC issues. Process, routes and tracks incoming service requests. Performs basic desktop PC support mainly via telephone. Logs calls in trouble ticketing system. Provides follow-up phone calls and/or investiga ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #248
    Monday, August 19, 2019
    Status: Full-time, Exempt: No Summary: Knows and interprets MVP contracts, riders, policies, and procedures. Receives calls and written request from providers and other departments regarding authorization issues. Follows up on member/provider issues or transfers call to nurse when appropriate. Researches questions and concerns from hospitals and providers requiring written & phone authorizations. Makes outgoing calls to provide members/providers with determinations (i.e. authorization numbers) ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #249
    Monday, August 19, 2019
    Status: Full-time, Exempt: NoThis is a full-time position assigned to work every weekend (Saturdays and Sundays), with additional days during the week. Responsible for electronic filing and distribution within the document retention system of all documentation received within the Clinical Operations Support Intake Unit. Retrieves medical documentation from files when necessary and prepares it for processing. Responsible for retrieving, sorting, and distributing mail to various individuals within ... More
  • Headquarters Office
    Req #234
    Thursday, August 15, 2019
    Status: Full-time, Exempt: No Summary: This role is responsible for all lines of business inpatient claims queue work. Reviews incorrect claims for inpatient/outpatient services. May review DME and Case Management claims. Is responsible for the Retro Review process as it pertains to medical record requests and processing incoming charts. Responsible for DRG and Retrospective Review record requests to appropriate hospitals. Knows and interprets the MVP benefits program, policies and protocols ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #237
    Thursday, August 15, 2019
    Status: Full-time, Exempt: No Summary: Analyzes and provides coding review with recommendations for processing and payment of outpatient and surgical claims rendered by participating and non-participating physicians. Reviews claim modifiers and responds to correspondence and telephone calls from  physicians and/or their staff. Processes multiple levels of appeals for all of the medical staff. Assists with the development and refinement of policies and procedures associated with physician ... More
  • Headquarters Office
    Req #240
    Wednesday, August 14, 2019
    Status: Full-time, Exempt: This position will execute and maintain oversight of compliance-related projects/programs, QC of appeal and complaint cases, and trending areas in need of education and providing that education for the Appeals Department. Intake and QC of all Behavioral Health appeals, correspondence and complaints in absence of Intake Coordinator. Provides direction, implementation support, and oversight for new and current departmental processes in support of optimal accredit ... More
  • Headquarters Office; Tarrytown Office
    Req #238
    Wednesday, August 14, 2019
    Status: Full-time, Exempt: Yes   Supports the strategic goals of the Health Management department through expert application of process improvement and process/project management disciplines and technique both within and outside of Health Management as appropriate. Responsibility for projects includes the direction, coordination, implementation, execution, controls and completion of project, while remaining aligned with strategy, commitments and goals of the organization. Directs through ... More
  • Headquarters Office
    Req #207
    Wednesday, August 14, 2019
        Status: Full-time, Exempt: Yes       Summary: The position will provide support to MVP members who are at risk for readmission. MVP’s Transition Care team will outreach members post hospitalization, to assist them in overcoming major “barriers to care”. This coaching is done through a variety of methods such as home visits and telephonic support, as well as video visits. The goal of the Transition Care team is to improve the health outcomes of these at risk members and reduce MVP’ ... More
  • Headquarters Office; Rochester Office
    Req #186
    Wednesday, August 14, 2019
    Status: Full-time, Exempt: No            Summary:  This position will serve as the first point of contact to members identified for MVP’s Integrated Medical/Behavioral Care Management Programs. As the first point of contact for these programs, the responsibility for efficient, customer service-oriented telephone interface is paramount. The Patient Engagement Specialist will: Lead efforts to locate and engage new and previously hard-to-engage members. This individual works to overcome lang ... More
  • Rochester Office; Tarrytown Office
    Req #244
    Wednesday, August 14, 2019
    Summary:Under the direction of the Leader, Revenue Data Management – NYS Encounter, OperationsPerform daily operations for NYS. Encounter operations including but not exclusive to; file submissionsand reconciliation, data integrity reviews, IT request ticket management, develop and perform applicationtesting functions, reporting, and supporting business partner functions for Revenue Data Management.  Actively participates in the development testing and implementation of technical solutions to me ... More
  • Tarrytown Office
    Req #236
    Tuesday, August 13, 2019
     Status: Full-time, Exempt: Yes   Manages hospital/health system relationships including negotiations of rates, reimbursement methodologies, issue resolution, and contract language. Responsible for maintaining a positive professional working relationship between MVP and hospitals/health systems. Uses data on cost, utilization and other data trends as part of the negotiation process. Uses Medicare, Medicaid and MVP proprietary reimbursement methodologies to analyze and negotiate new and renewe ... More
  • Rochester, NY, US; Schenectady, NY, US
    Req #88
    Tuesday, August 13, 2019
     Status:Full-time, Exempt: YesThe Software Engineer is a critical part of this transformation.  As a member of a Scrum team, the Software Engineer has responsibility for planning, designing, and developing applications for MVP. The engineer works with business and technology partners to deliver software solutions to support the business. The Software Engineeralso works alongside other engineers on the team to elevate the codebase andapply coding best practices.The role includes but is not limite ... More
  • Headquarters Office; Rochester Office
    Req #215
    Friday, August 9, 2019
    Status: Full-time, Exempt: Yes This position will utilize the essentials of an integrated case management modelthat includes assessment, planning, implementation, care coordination,monitoring and advocacy to meet the member’s overall comprehensive healthneeds. Through collaborative efforts the Case Manager will identify the medicaland psycho-social needs of designated members, act as a proactive partner, andprovide appropriate education, resources and healthcare coaching telephonicallyor “fac ... More