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  • Burlington Office, 62 Merchants Row, Williston, VT, USA
    Req #420
    Tuesday, January 28, 2020
    Professional, Sales Rep - Medicare   Status: Full-time, Exempt: Yes  SUMMARY: Conduct all phases of selling including identify, qualify and meet with prospective clients located in the lower Vermont region (Bennington, Windam, Rutland, Windsor, Orange, Addison and Washington County) for purposes of presenting Medicare Advantage (MA) products  and services to meet company and individual enrollment goals. Assure understanding level  of each enrollee  by providing clear,  complete and accurate info ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #412
    Tuesday, January 28, 2020
    Leader, Field Operations  Summary:     Responsible for outreach and promotion of MVP lines of business to individuals and community groups from target market. Supervises diverse team of outreach representatives. Ensure that the Team’s productivity meets projected targets. Works closely with the Department of Social Services staff and the staff of affiliated Health Centers. Assist the Retail Outreach Manager in implementing the regional team strategy.   Perform annual performance evaluatio ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #413
    Tuesday, January 28, 2020
    Status: Full-time, Exempt: Yes    The Quality Management (QM) Behavioral Health (BH) Liaison will, along with internal and external stakeholders, assess the clinical and service needs of MVP Health Care members with behavioral health (BH) conditions. The QM BH Liaison will work directly with regulators (DOH, OMH) and BH clinical area for the child populations including medically fragile children, children in foster care, and have strong knowledge of the community and family-based services an ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #456
    Monday, January 27, 2020
    Status: Full-time, Non-Exempt      Summary: Supports the credentialing and re-credentialing process by performing the following responsibilities: Data Entry of Credentialing information into Cactus; Intake of credentialing related information including conducting on-line credentialing verifications; Reviews and prepares all new applications received. Downloads applications from CAQH, as necessary; Prepares monthly recredentialing mailing; Distributes incoming department mail; Filing of Com ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #449
    Friday, January 24, 2020
    This position works as part of an integrated team designed to provide cross-functional communication and marketing expertise to the business with a focus on health management and quality programs, as well as provider communications.  Overall team objectives include, but are not limited to: identifying, developing, and utilizing the most appropriate communication vehicle(s) to reach the targeted audience; create, plan, and provide communication solutions designed to help retain existing members a ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #438
    Thursday, January 23, 2020
    Status: Full-time, Exempt: Yes Performs DRG and Retrospective Review for inpatient admissions and claim review for all regions.  Performs DRG Validation submitted by hospitals/facilities for all regions, which have contractual agreements with MVP for case rate/ DRG payment methodology.  Utilizes ICD-10-CM Coding Guidelines and other clinical criteria to validate accurate code assignment for diagnoses and procedures including correct sequencing of the coding using the 3-M DRG Grouper. The in ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #452
    Thursday, January 23, 2020
    Summary:In this position, your goal is to develop, improve, and maintain the digital customer experiences on mvphealthcare.com and post-login environments from a Marketing & Communications perspective. You will oversee and coordinate user requests to update content and fix/troubleshoot issues while maintaining a consistent and clean back-end structure. You are also responsible for usability, accessibility, and user interface best practices.This position will work closely with the content strateg ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #451
    Thursday, January 23, 2020
    In this position, your goal is to help grow brand awareness and loyalty by creating and implementing adigital marketing website and content strategy. You are responsible for the content creation across website and email marketing, as well as paid digital campaigns. You will work collaboratively across the Marketing & Communications team and other business areas, creating processes for requestsand management of digital content.   This position is responsible for making sure all digital commu ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #450
    Thursday, January 23, 2020
    Status: Full-time, Exempt  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 service ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #453
    Wednesday, January 22, 2020
    Associate, Office Assistant  Position Summary:Responsible for back up coverage for reception areas, ensuring the representation of MVP Health Care in a professional manner through telephone and direct contact with all customers and employees. Provide general clerical support to the Customer Care Team as needed. Position Qualifications: High School diploma or equivalent. Must be customer service oriented and have excellentcommunication and interpersonal skills.Knowledge of computers and relevant ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #444
    Wednesday, January 22, 2020
    Full-time, Non-Exempt   Summary: Conducts verification of and processes credentialing and recredentialing applications of providers and organizational facilities in accordance with MVP Policies, NCQA standards, CMS, NYS Department of Health and other regulatory agencies. Processes Credentialing and Recredentialing Applications for practitioners and organizational providers including preparing files for the MVP Credentials Committee. Conducts primary source verifications from various source ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #274
    Wednesday, January 22, 2020
    Associate, Outreach Representative    Summary: 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 ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #448
    Friday, January 17, 2020
    Full-Time, Non-ExemptUsing 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 adjudication ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #446
    Thursday, January 16, 2020
    Full-time, Non-ExemptUsing 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 adjudication ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #439
    Wednesday, January 15, 2020
    Associate, Administrative Assistant   Summary: Performs administrative functions and provides general administrative support for the Community Engagement and Marketing & Communications Departments and handles a variety of clerical, secretarial, and organizational functions. Daily oversight of job functions by Community Engagement Director. Schedules meetings and maintains calendars; Creates and formats per brand communications guidelines documents and PowerPoint presentations; Performs gen ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #441
    Tuesday, January 14, 2020
    Associate, Care Center Senior Representative Medicaid   SUMMARY:Provides optimum customer service as required to maintain existing members and prevent cancellations. The Senior Care Center Representative must take full responsibility for every call to ensurecallers concerns are met. Provides world class customer care to internal and external customers while consistently adhering to all call handling objectives, i.e. hold time, talk time, after call work, schedule adhere and quality assurance. Co ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #445
    Tuesday, January 14, 2020
    Status: Full-time, Exempt           Summary: The Configuration Analyst develops and implements configuration into the Facets system to accommodate systematic adjudication rules and benefit plan requirements. Responsible for the interpretation of requests, development of solutions and creation of configuration to support efficient and accurate claim adjudication. Performs system testing and utilizes quality assurance methods to validate accurate system configuration. Performs post impleme ... More
  • 220 Alexander St, Rochester, NY 14607, USA; 625 State St, Schenectady, NY 12305, USA
    Req #88
    Tuesday, January 14, 2020
    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. The Software Engineer is a critical part of this transformation.  As ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #437
    Friday, January 10, 2020
    This position is located in Schenectady, NY.This position will report to the Senior Leader, Enterprise Risk Management (ERM) and oversee MVP’s business continuity management activities necessary to keep thebusiness running effectively and efficiently during and after a disruptive event. As part of the ERM team, the incumbent may also assist with other risk management activities. The role includes but is not limited to the following: Scale and maintain a BCM program that aligns to industry stand ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #301
    Friday, January 10, 2020
    Status: Full-time, Exempt: NoSummary: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. Is r ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #440
    Thursday, January 9, 2020
    Professional, Small Business Sales   This role will maintain and grow small business through MVP’s broker distribution channel and individual market. Must meet or exceed membership and retention goals for the following market segments: Small Group 1-100 eligibles, both on and off exchange to ensure all service protocols, productivity, sales and quality standards are being met. This individual will develop new distribution channels to support commercial growth in target markets and products. The ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #443
    Thursday, January 9, 2020
    Provide administrative support to the Human Resources Leadership team Maintain calendars for the CHRO and other members of HRLT as requested, schedule and coordinate onsite and offsite meetings, screen inquiries to the department, meet and greet clients/visitors, perform advance preparation of agendas for meetings, arrangement of travel and completion of expense reports for leadership. Interact regularly with external constituencies serving as an effective conduit of information for the team. Ha ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #418
    Thursday, January 9, 2020
    Professional, Mktg & Communications -  Medicare  SUMMARY:  MVP Health Care is seeking an experienced Marketing & Communications professional to join our team. We are looking for an enthusiastic, creative and driven individual to provide marketing and communication expertise to the business. The ideal candidate will need to have a strong understanding of traditional and digital marketing tactics with proven project management skills. In this role you will: Partner in the planning, development and ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #406
    Thursday, January 9, 2020
    Location: Schenectady, NY This position works as part of an integrated team designed to provide cross-functionalcommunication and marketing expertise to the business with a focus on the Commercial line of business.  Overall team objectives include but are not limited to: identifying, developing, and utilizing the most appropriate communication vehicle(s) to reach the targeted audience; create, plan, and provide communication solutions designed to help retain existing members and acquire new me ... More
  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #428
    Wednesday, January 8, 2020
    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 follow up of ... More