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  • Headquarters Office; Rochester Office
    Req #265
    Friday, August 30, 2019
    This individual will perform and be cross-trained in selected departmental job functions as assigned. These include, but are not limited to: Working as part of team to coordinate all aspects of P+T Committee, with appropriate notification to physician, member, and vendor; Supporting the QI pharmacy initiatives, as well as disease state management functions of the pharmacy department; Providing drug related and benefit information to member services, provider relations, utilization management an ... More
  • Headquarters Office
    Req #271
    Thursday, August 29, 2019
    Status: Full-time, Exempt     This role works with the CRM staff, Marketing & Communications, Business Areas, and the IT Development team to develop the training program for specific CRM initiatives and applications. This position will design, write, and develop instructor-led and technology delivered courses using content developmental tools and will work with business experts to refine course content based on process and training needs, while meeting MVP brand and communication standards. The ... More
  • Headquarters Office
    Req #272
    Thursday, August 29, 2019
    Status: Full-time, Non-Exempt     Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate ... More
  • Headquarters Office
    Req #263
    Thursday, August 29, 2019
    Performs review of Durable Medical Equipment, Orthotics, prosthetics and other specialty equipment and related services for medical necessity. Applies established Medicare Guidelines or Benefit Interpretation criteria and standards. Responsible for collecting and interpreting medical information for appropriateness of care. Communicates determinations to all parties involved, verbally and in writing, including scope of authorization. Facilitates deployment of services and conducts retrospective ... More
  • Tarrytown Office
    Req #145
    Thursday, August 29, 2019
    Associate, Outreach Representative    The Outreach Representative conducts individual and group Field Outreach activities throughout their regions; promotes MVP throughout their regions, and conducts public presentations on MVP products. The Outreach Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the NY State of Health Marketplace. They help facilitate enrollment in Qualified Health Plans (QHPs), insuran ... More
  • Schenectady, NY, US
    Req #74
    Thursday, August 29, 2019
     Summary:This position will be primarily responsible for performing independent and objective auditing and monitoring of the Company to ensure compliance with all applicable laws, regulations and policies/procedures. Independent auditing and monitoring includes: conducting audits and monitoring, analyzing results, recommending corrective actions, creating reports, educating and following up with the business areas to ensure the implementation of corrective actions. This position holds primary re ... More
  • Headquarters Office; Rochester Office
    Req #267
    Wednesday, August 28, 2019
    Status: Full-time, Exempt   Summary:      This role is responsible for developing reports and analysis for consumption by internal and external department customers using a variety of company data sources in support of the information requirements for the Operations Department including Claims, Member services, and Managed Care Systems areas. Presents and explains results of analyses internally and externally. Architect, design, implement, and support a platform providing secured access to large ... More
  • Headquarters Office
    Req #266
    Tuesday, August 27, 2019
    Summary:Installs desktop hardware and software and performs routineequipment maintenance. Works closely with end users as well as senior andexecutive level leadership to provide support and resolve software/hardwareproblems. Logs all incidents and troubleshooting details in the incidenttracking software. Maintains desktop asset records and assists with the equipmentprocurement process. Participates in implementation of desktop PC upgrades andrelated corporate projects. Maintains the company’s PC ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #261
    Friday, August 23, 2019
    Status: Part-time, Exempt: NoPart-time opportunities available, working only weekends, every Saturday and Sunday.  Number of hours are flexible.  Weekend hours are able to be worked remotely once on-site training is complete.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 ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #262
    Friday, August 23, 2019
    Status: Full-time, Exempt: Yes      Provides oversight on activities/functions for day to day operations. Responsible for configuration of all Medical Management application(s). Works with different teams to establish well documented guidelines and process documentation. Ensures documentation and tracking sheets are kept updated. Responsibility for identifying and solving problems related to Medical Management processes and Application configuration, and overall Medical Department transition ... More
  • Headquarters Office
    Req #264
    Friday, August 23, 2019
    Intern – Operations, Hourly   The CRM Intern will support the implementation of a new CRM solution at MVP.  The project will focus on researching, validating and assembling a proposed business plan focused on addressing and rationalizing digital servicing and engagement capabilities within our CRM program for MVP prospects and members.  The project will study and assemble recommendations for self-service capabilities and value-added content and functions for our member portal and mobile (inclu ... More
  • Headquarters Office
    Req #250
    Friday, August 23, 2019
    Professional, Professional Relations External Status: Full-time, Exempt: Yes Summary:Represents MVP Health care in a professional and ethical manner, while enhancing thecorporate image and mission to new and existing provider customers. Providessuperior services to network providers, remotely and in the provider’s offices.Orients and educates new and existing physicians and office staff. Proficientin provider demographics management, claim resolution and other types ofprovider related issues. M ... More
  • Tarrytown Office
    Req #258
    Friday, August 23, 2019
    Summary:Installs desktop hardware andsoftware and performs routine equipment maintenance. Works closely with endusers as well as senior and executive level leadership to provide support andresolve software/hardware problems. Logs all incidents and troubleshootingdetails in the incident tracking software. Maintains desktop asset records andassists with the equipment procurement process. Participates in planning andimplementation of desktop PC upgrades and related corporate projects. Maintainsthe ... More
  • 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
  • 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; 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
  • 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
    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; 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; 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