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  • 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
    Req #233
    Wednesday, August 7, 2019
    As Leader, Informatics Products, you will have the opportunity to think creatively about what insights can drive improved health outcomes and care delivery efficiencies; you’ll build reporting and business intelligence tools that provide actionable information to internal and external partners. This role works with business units and disciplines across MVP to maintain and further develop an internal distribution system for reports, analytics, and dashboards that support product and service evolu ... More
  • Headquarters Office
    Req #231
    Wednesday, August 7, 2019
    Professional, Informatics AnalystLocation: Schenectady  Summary: 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 mo ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #213
    Tuesday, August 6, 2019
    Status: Full-time, Exempt: YesObtain and analyze monthly data required for NCQA standards, HEDIS/QARR measures and CMS Star quality ratings. Interpret these findings, identify barriers, and propose methods for improvement. Collaborate and communicate with internal departments to implement effective interventions that support NCQA health plan accreditation and the increased performance of HEDIS/QARR/STARS rates. Develop documentation and reporting tools to allow QI to track the progress and succe ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #214
    Tuesday, August 6, 2019
    Status: Full-time, Exempt: No This position will contact targeted members from the Medicaid line of business who are eligible for MVP’s Rewarding Quality Incentive program. In addition, they will make calls to members from all lines of business, as needed, for focused outreach programs. As the personal point of contact for these programs, the responsibility for efficient, customer service-oriented telephone interfaceis paramount. The individual will: • Lead efforts to locate and engage ne ... More
  • Rochester Office; Tarrytown Office
    Req #229
    Monday, August 5, 2019
    Status: Full-time, Exempt: Yes Leader, Regional VBP AccountManagementStatus: Full-time, Leader IVPosition Summary Responsiblefor Provider Partner business development, strategic account management, negotiatingVBP and alternate payment model contracts in the region and implementingstrategic account plans for key provider relationships representing a significantproportion of MVP’s membership and clinical expenditures.  Works with Network leadership, team members,key leaders/contributors across t ... More
  • Headquarters Office
    Req #226
    Friday, August 2, 2019
    Status: Full-time, Exempt: Yes The role tasked with effectively engaging our par providers to successfully make the transition from Fee-For-Service to Value-Based Payment (VBP), Alternate Payment Models (APM) and Integrated Behavioral Health. With NYS and CMS supporting this transformation, and MVP wholly committed to it, this position will oversee, under the direction of senior leadership the engagement of provider partners in sustainable VBP arrangements, VBP and APM contracting, strategic a ... More
  • Headquarters Office; Rochester, NY, US; Tarrytown, NY, US
    Req #187
    Thursday, August 1, 2019
     Summary:Be a part of the transformation at MVP Health Care.  This position is a critical part of this transformation.  As a member of a Scrum team, the role is primarily responsible for ensuring that quality products are delivered to the organization. The candidate will work with a cross-functional team to understand business requirements and break them into user stories, develop test plans, test cases and execute test scenarios to ensure we are delivering high quality code.  The ideal candidat ... More
  • Rochester, NY, US; Schenectady, NY, US; Tarrytown, NY, US
    Req #216
    Tuesday, July 30, 2019
    Summary:Primary responsibilities include preparation of standard and adhoc analysis in support of key corporate initiatives for MVP’s business departments. Analyses involve independent structuring of a study including initial evaluation of the request, extraction of data from a warehouse using identified standard set of tools to manage large sets of data and production of high quality, professional reports for distribution. Ability to produce and review trend reports, perform budget-to-variance ... More
  • Schenectady, NY, US
    Req #211
    Friday, July 26, 2019
     Summary:Be a part of the transformation at MVP Health Care.   This position is a critical part of this transformation.  As a member of a Scrum team, this role is primarily responsible for that ensuring quality products are delivered to the organization. The candidate will work with a cross-functional team to understand business requirements and break them into user stories, develop test plans, test cases and execute test scenarios to ensure we are delivering high quality code.  The ideal candid ... More
  • Tarrytown Office
    Req #210
    Friday, July 26, 2019
    Associate, Integrated Care Medicaid       Summary: Responsible for interacting with health care professionals and members to supply computer generated authorizations for designated medically necessary services. This position provides telephonic outreach to members and health care providers to ensure coordinated health care services are in place and the patient’s established health care needs are being met. This position also strongly supports the Long Term Services and Supports prog ... More
  • Headquarters Office; Rochester Office
    Req #183
    Monday, July 22, 2019
    This role will be responsible for the mapping the “as is state”, the “desired end state” and the steps necessary to evolve. Will focus on process measurement, change management and optimization of MVP’s processes across the enterprise. Focus on research and development – enabling new technologies to enhance current business processes. Assures new processes and sub-processes integrate appropriately with other business processes. Responsible for continued maintenance to and formal amendment of all ... More
  • Rochester Office
    Req #198
    Monday, July 22, 2019
     POSITION:Professional, Field Events & Promotions, Marketing & Communications SUMMARY: MVP Health Care is seeking an experienced Marketing & Communications events professional to join our team. We are looking for an enthusiastic, creative, and driven individual to provide experiential marketing and event execution expertise to the business. The ideal candidate will need to have a strong understanding of event management and execution with proven project management skills. You will: Design, i ... More
  • Headquarters Office
    Req #197
    Friday, July 19, 2019
    Status: Full-time, Exempt: Yes Summary:Prepares Financial Statements and detailed financial reporting for assigned companies and IPAs, PHO arrangements, when needed. Performs accounting duties and produces monthly reports and analyticals for assigned companies. Identifies variances and financial trends for revenue and expense line items. Posts and tests assigned interfaces to general ledger. Reconciles IPA/HMO intercompany accounts. Performs bank account reconciliations and general ledger accou ... More
  • Headquarters Office
    Req #188
    Wednesday, July 17, 2019
    Sr Leader, Actuarial, Medicare Status: Full-time, Exempt: Yes The Actuary will lead a team of analysts in managing all responsibilities related to setting and filing CMS Bids for Medicare Direct Bill as well as setting premium rates / factors and experience rating methodologies for the Medicare Employer Group Market. The Actuary must work collaboratively with Network, Informatics, Product and Finance and manage work flow and dependencies with external Actuarial consultants as needed. The Actua ... More
  • Headquarters Office
    Req #179
    Friday, July 12, 2019
    Associate, Provider Services, Care Center RepresentativeStatus: Full-time, Exempt: No       Summary: Responsible to address member/subscriber/provider inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Majority of contact is via telephone, with some in-office contact and written correspondence/e-mail as needed. Position handles a variety of insurance types including HMO, POS, PPO, ASO, Inde ... More
  • Rochester Office
    Req #172
    Wednesday, July 10, 2019
    Associate, Provider Services, Care Center Representative Status: Full-time, Exempt: No         Summary: Responsible to address member/subscriber/provider inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Majority of contact is via telephone, with some in-office contact and written correspondence/e-mail as needed. Position handles a variety of insurance types includin ... More
  • Rochester Office
    Req #165
    Wednesday, July 10, 2019
    Status: Full-time, Exempt: No         Summary: Responsible to address member/subscriber/provider inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Majority of contact is via telephone, with some in-office contact and written correspondence/e-mail as needed. Position handles a variety of insurance types including HMO, POS, PPO, ASO, Indemnity, NY and VT Exchange plan ... More
  • Headquarters Office
    Req #163
    Tuesday, July 9, 2019
    Status: Full-time, Exempt: Yes     Summary:This role will provide support to the company in performing necessary day-to-day Actuarial tasks. Assistsin premium rate development for MVP’s blocks of business. Develops, refreshes and analyzes financialforecasts and projections. Reviews actuarial models used to project future claim liabilities. Works toanalyze MVP’s financial statements. Analyzes and refines current methodologies used for premium ratedevelopment and reserving. Performs other ... More
  • Headquarters Office; Rochester Office; Tarrytown Office
    Req #159
    Tuesday, July 9, 2019
       Full-time, Exempt: Yes   Summary: The Behavioral Health Leader provides professional oversight, leadership and guidance over the day-to-day operation of the Behavioral Health Care Management Team. Ensures the development, implementation, coordination, and evaluation of the Team’s job responsibilities. Develops and monitors productivity metrics. Performs quality checks, audits, coordinates interrater reliability activities, and supports the team in meeting their prod ... More
  • Headquarters Office
    Req #173
    Tuesday, July 9, 2019
    Status: Full-time, Exempt           Summary: This role will be responsible for the mapping the “as is state”, the “desired end state” and the steps necessary to evolve.  Will focus on process measurement, change management and optimization of MVP’s CRM processes across the enterprise.  Focus on research and development – enabling new technologies to enhance current business processes.  Assures new processes and sub-processes integrate appropriately w ... 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 #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