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  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #154
    Tuesday, July 2, 2019
    Status: Full-time, Exempt: Yes Provides clinical expertise and timely first and second level clinical determinations based on MVP’s policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary. May conduct pediatric reviews. Lead’s MVP’s efforts to collaborate in person and virtually with behavioral health network providers and facilities around clinical determinations, policy interpretation ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #137
    Tuesday, July 2, 2019
       Status: Full-time, Exempt: Yes SUMMARYThis position will be responsible for managing the annual medical record review project to include collection of medical records, abstraction, and coordination with vendors and temporary staffing agencies. HEDIS operations includes data acquisition, chart abstraction, compliance with NCQA audit regulations and requirements and HEDIS data analysis. The individual is responsible for developingand managing year-round provider education ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #151
    Monday, July 1, 2019
        Status: Full-time, Exempt   Summary: Leads MVP’s efforts to enhance business discipline of and collaboration between Utilization Management, Case Management, Appeals and other divisions of the Health Management Department to improve clinical outcomes across all business lines.Co-leads Medical Operations’ efforts to vision, implement and execute on an Integrated Health strategy.Leads Medical Operations efforts to implement and execute Quality initiatives in a highly matrixed environmen ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #147
    Monday, July 1, 2019
    Status: Full-time, Exempt Summary: Provides clinical expertise and timely first and second level clinical determinations based on MVP’s policies/procedures, state and federal guidelines, national accreditation standards, benefits interpretations, and other medical necessity criteria as necessary.Supports MVP’s efforts to enhance business discipline of and collaboration between Utilization Management, Case Management, Appeals and other divisions of the Health Management Department t ... More
  • Rochester, NY, US; Schenectady, NY, US; Tarrytown, NY, US
    Req #141
    Monday, July 1, 2019
    SummaryThe Business Intelligence (BI) Engineer works with analysts and business stakeholders to understand a business problem, need or opportunity in order to gather requirements, and then to design and build high performance solutions/reports focusing on maintainability, automation and the end-user.Creates scalable, maintainable, and reliable business intelligence infrastructure. Partners and collaborates with other technology teams to extract, transform, and load data for wide variety of poten ... More
  • Rochester Office
    Req #146
    Monday, July 1, 2019
    Professional, Medicare Process Manager Status: Full-time, Exempt: Yes     Summary: This individual acts as a Subject Matter Expert of Medicare Part C & D Regulations and Guidelines and champions excellence in all operational areas affecting the Medicare products and members. Responsibilities include: reading, interpreting and coordinating implementation of MVP impacts from new Medicareguidelines, regulations and Health Plan Management System (HPMS) memos;  leading teams to ensure operatio ... More
  • Headquarters Office; Rochester Office
    Req #132
    Friday, June 28, 2019
    Status: Full-time, Exempt: Yes      Monitors Pharmacy programs to ensure they are meeting stated goals and objectives and routinely reports status to Pharmacy management. Ensures Pharmacy work plan reflects progress of activities. Coordinates/tracks project tasks and implementations to ensure timely completion/on-time finish. Maintains master departmental compliance grid and internal policy manual and ensures that all policies are r ... More
  • Headquarters Office; Rochester Office
    Req #133
    Friday, June 28, 2019
       Status: Full-time, Exempt: No Summary: This position will help licensed pharmacists take care of many of the daily operations of the pharmacy department. Including, but not limited: Calling Providers, members, and pharmacies. Providing drug-related information to Customer Care Center and other internal departments. Managing incoming faxes requesting drug coverage; Determining eligibility and pre-authorization necessity, obtaining additional information and initi ... More
  • Headquarters Office; Tarrytown Office
    Req #142
    Friday, June 28, 2019
    SUMMARY:The Program Manager, Medicaid Operations, will accomplish strategicobjectives by leading multiple projects and initiatives for MVP’s governmentprograms. The Program Manager is responsible for monitoring program changes inaccordance with State regulatory guidelines by analyzing new and existingcontract requirements for downstream organizational implications. Develops anddisseminates periodic communications to ensure organizational partners areinformed of Medicaid program requirements and ... More
  • Schenectady, NY, US
    Req #138
    Thursday, June 27, 2019
    Professional, Microsoft Compute Engineer Be a part of the transformation at MVP Healthcare. MVP Healthcare is a nationally-recognized, regional not-for-profit health plan. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,600 employees.  We are continually evolving the way MVP uses technology to grow our business, transforming the organization through Cloud Computing, Agile Delivery, and DevOps. MVP Informat ... More
  • Headquarters Office
    Req #140
    Tuesday, June 25, 2019
    Status: Full-time, Non-Exempt           Summary: Perform continuous keying of multiple claim form types such as Medical, Dental and miscellaneous documents from both electronic images on screen and paper documents at a PC workstation into the PCS application. Demonstrated ability to work in a team environment and present a positive professional attitude at all times and work with other areas as required. Ability to meet department standards for Production and Qual ... More
  • Headquarters Office; Rochester Office
    Req #136
    Monday, June 24, 2019
        Status: Full-time, Exempt: Yes     Summary: This individual 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 this individual will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate edu ... More
  • Headquarters Office
    Req #112
    Thursday, June 20, 2019
    Associate, Broker Program       Summary: The Broker Coordinator will be responsible for completing Broker applications, appointments and perform analytical support. Specific responsibilities include updating Brokers E& O Certificates and Licenses. Assisting with the Broker Customer Service Email box and answering the Broker Customer Service phone queue. Research commission issues, coordinates manual adjustments with Finance, and resolves conflicts resulting from commiss ... More
  • Headquarters Office
    Req #130
    Thursday, June 20, 2019
    Status: Full-time, Exempt           Summary: This is a brand-new position within MVP’s Operations department aligned with MVP’s Core System Enablement strategy. MVP is launching several exciting new initiatives over the upcoming months and quickly building out our team. The role includes, but is not limited to the following activities: This role will work closely with all departments implementing and ensuring the core system wor ... More
  • Headquarters Office
    Req #119
    Wednesday, June 19, 2019
    Associate, AR Status: Full-time, Exempt:No        SummaryThe role is responsible for overseeing, reconciling, auditing and tracking of all assigned accounts which include Group accounts, Off Exchange Individuals, CHP (Child Health Plus), EP/QHP On-Exchange Individuals. Responsible for insuring that all premiums are collected in a timely manner from groups, members and government entities. Maintaining and ensuring that all appropriate accounts are being submitted to collections on a monthly basis ... More
  • Headquarters Office
    Req #129
    Wednesday, June 19, 2019
    Status: Full-time, Exempt: Yes           Summary: Manages the initial implementation, administration, and vendor relationships. Interacts with delegated vendors and MVP staff to resolve issues in a timely manner. Assists with other provider recruitment and contracting efforts as needed. Administers the vendor performance program for the Delegated Vendor Management Department and periodically audits compliance of internal MVP departments. Performs other ... More
  • Headquarters Office; Rochester Office
    Req #128
    Wednesday, June 19, 2019
    Status: Full-time, Non-Exempt           Summary: Monitors and records the quality of work performed by units within the Operations Department for pre-payment of claims and claims audits, for all regions in all lines of business. Identify trends in specific errors and error rates. Determines and recommends needs for retraining, or clarification of work procedures. Develops and produces, periodic reports based on audits/projects completed, for the Quality Control L ... More
  • Headquarters Office; Rochester Office; Tarrytown Office; Virtual
    Req #127
    Wednesday, June 19, 2019
       Status: Full-time, Exempt: Yes     Summary: In collaboration with the Chief Medical Officer and other stakeholders, responsible for developing and implementing strategies for: Enterprise-wide quality management leadership and integration o   Strategic leadership to move company culture towards enterprise-wide accountability and alignment around quality improvement o   Tactical leadership for enterprise quality team includ ... More
  • Headquarters Office; Rochester Office; Tarrytown Office; Virtual
    Req #126
    Wednesday, June 19, 2019
        Status: Full-time, Exempt: Yes Summary: In collaboration with the Chief Medical Officer and other stakeholders, responsible for developing and implementing health management strategies for: Care Management Programs Utilization Management Programs Integrated health model development (physical and behavioral health) Clinical integrati ... More
  • Rochester, NY, US; Schenectady, NY, US
    Req #125
    Monday, June 17, 2019
     Be a part of the transformation at MVP Healthcare. As a service-optimized IT organization we are focused on delivering business value to our customers and are continually evolving the way MVP uses technology to grow our business. The IT Governance Analyst has an essential role in the journey to a service-optimized IT organization.  Our IT Risk Management Analyst will primarily support IT Audit, Compliance and Risk Management activities required to enable our organization to reach its goals. As ... More
  • Rochester, NY, US; Schenectady, NY, US
    Req #124
    Monday, June 17, 2019
      Summary: Be a part of the transformation at MVP Health Care. Information Technology & Transformation Services (IT & TS), as a service-optimized IT organization, is focused on delivering business value to our customers and are continually evolving the way MVP uses technology to grow our business. The role has an essential role in our transformation to a service-optimized IT organization.    This position will support Department goals of implementing modern platforms for the enterprise while ... More
  • Rochester, NY, US; Schenectady, NY, US
    Req #123
    Monday, June 17, 2019
    Be a part of the transformation at MVP Healthcare. As a service-optimized IT organization we are focused on delivering business value to our customers and are continually evolving the way MVP uses technology to grow our business. The IT Governance Lead has an essential role in the transformation to a service-optimized IT organization. Our IT Governance Lead will support the effective and efficient use of IT in enabling our organization to reach its goals. The person in this role will help to des ... More
  • Tarrytown, NY, US
    Req #118
    Monday, June 17, 2019
          Summary: The Enrollment and Retention Call Center Representative must provide fair and impartial information to individual Marketplace customers regarding coverage options available through the Exchanges. They help facilitate renewal and enrollment in Qualified Health Plans (QHPs), insurance affordability programs, Medicaid, the Essential Plan, and Child Health Plus as permitted under federal and state guidance. Majority of contact is via telephone, wit ... More
  • Schenectady, NY, US
    Req #74
    Monday, June 17, 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
  • Tarrytown Office
    Req #116
    Monday, June 17, 2019
    Associate, Chart Procurement Specialist  Status: Full-time, Exempt: No       Summary: This position works with provider offices to obtain medical records for the purpose of the Risk Adjustment team validating diagnoses that were sent to CMS (Center for Medicare & Medicaid Services). Works to collect medical records under a sometimes very strict deadline. Contacts local provider offices to schedule appointments to obtain medical records using a laptop and mobil ... More