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Clinical Operations, Leader, Behavioral Health Case Management

Headquarters Office, Schenectady, New York, United States of America, Rochester Office, Rochester, New York, United States of America, Tarrytown Office, Tarrytown, New York, United States of America Req #162
Wednesday, July 3, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Status: Full-time, Exempt: Yes

This position will provide oversight, leadership and direction for the implementation of focused case and disease management interventions targeted to improve member and provider satisfaction, decrease cost waste, maximize quality and improve clinical outcomes.  Residency in NY is mandatory.  Responsibilities include but are not limited to:

  • Development and support Care Management and Health Management Programs that are provider inclusive and member centric. 

  • Support of Integrated Health model development across all CM activities.

  • Development and support of initiatives that promote effective level of care transitions,
    maximize care access for members and promote engagement with health care team.

  • Execution of workplans, monitorings results, developing and documenting progress reports.

  • Establishment of targets for case management and disease management cost containment.

  • Planning, development, implementation and evaluation of processes and guidelines for
    managing care across the health care continuum for MVP Health Care members
    enrolled in case management and disease management.

  • Technology enablement and operational excellence.

  • Oversee development and implementation of case and disease management tools that
    incorporate peer reviewed clinical guidelines and represent “best practices”.

  • Regulatory compliance and accreditation for clinical programs.

  • Participation in the development and provide leadership in the implementation of new case and disease management strategies and initiatives.

  • Ensure external regulatory and review agency requirements involving case and disease
    management are met.

  • Development and monitor department’s annual budget.

  • Responsible for orientation, ongoing coaching and mentoring of Case and Disease Management leaders. Promote a spirit of cooperation, collaboration and integration with others.

  • Establish clear directions, set challenging, but achievable performance objectives,
    prepare performance reviews and action plans for direct reports.

  • Responsible for orientation, hiring, ongoing coaching and mentoring of Case and Disease Managers

  • Coordination with Quality Management and Utilization Management regarding outcome and targeted quality metric improvement.

  • Complete other duties regarding Case Management as assigned by Senior Leadership.


Minimum Education:

R.N., L.icensed Clinical Social Worker. Licensed Psychologist, Licensed Marriage and Family
Therapist, Licensed Mental Health Counselor, Licensed Masters Social Worker with active license in New York required;

Masters’ degree in Nursing, Business or other related area strongly preferred. 

Minimum Experience: 

Eight (8) years varied health-related experience. 

A minimum of (5) years of experience/management experience required within a licensed MCO.

Program development experience required. 

Case Management experience/certification preferred.

Significant experience with NCQA

Regulatory or accreditation audit experience

Experience in Medicaid, Medicare and Commercial products with experience working with vulnerable

Experience in integrated health delivery (physical and behavioral health) a strong plus

Experience working with Health Homes recommended

Experience working with community and family-based services
and experience in working across child serving systems recommended.

Required Skills:

  • Highly skilled functioning in a highly matrixed environment

  • Flexible management style

  • Superior communication skills; ability to organize and present data

  • Ability to use discretion in handling confidential information

  • Superior priority setting and time management abilities

  • Strong data and system skills

  • Some travel required within MVP’s service area

  • Ability to work independently and prioritize multiple assignments to meet deadlines.

  • Knowledge of NYS child serving systems required.



MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at

Other details

  • Job Family Medical Management/Clinical
  • Pay Type Salary
  • Headquarters Office, Schenectady, New York, United States of America
  • Rochester Office, Rochester, New York, United States of America
  • Tarrytown Office, Tarrytown, New York, United States of America