Job Description

Professional, Case Manager, Medicaid Long Term Support Program

Headquarters Office, 625 State Street, Schenectady, New York, United States of America * Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America

• Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America
• Virtual Req #1576

Monday, June 26, 2023

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it\'s time to make a healthy career move to MVP!

Status: Full-time, Exempt

This position will utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. 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, coordination of care and resource allocation. The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. In addition, the position will provide guidance in understanding benefit coverage and navigating the health care delivery system. The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Other duties as assigned by supervisor.

This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown).

POSITION QUALIFICATIONS

Minimum Education:

• Current New York State Licensure as a Registered Nurse required.
• Bachelor\'s degree in nursing preferred
• Case Management Certification a Plus (ANCC or CCM)
• Certification in Case Management required within 24 months after hire.

Minimum Experience:

• At least 3 years of recent clinical and Case Management experience.

• Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home preferred.
• Experience with Medicaid programs and benefits strongly preferred

Required Skills:

• Ability to professionally communicate with members, and all interdisciplinary team members.
• Excellent oral and written communication skills
• Demonstrated clinical knowledge including an understanding of population health management and the case management process.
• Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
• Ability to work in an energetic team environment.
• Experience with situations requiring strict adherence to confidentiality.
• Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.

• Ability to make independent decisions regarding resource utilization, and quality of care.
• Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations.
• Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (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), and the Know your Rights 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 hr@mvphealthcare.com

Please apply and learn more - including how you may become a proud member of our team.

Other details

• Job Family Medical Management/Clinical
• Pay Type Salary

MVP Health Care