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Behavioral Health, Professional, Behavioral Health_B

Rochester Office, 220 Alexander Street, Rochester, New York, United States of America Req #399
Tuesday, November 12, 2019
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 more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Professional, Behavioral Health

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 outpatient services occur.  The position will provide case management/ care coordination for members to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual’s behavioral health needs. The individual will review requests for all outpatient care plans for both mental health or substance services, using MVP’s Utilization Management programs for entering and tracking cases, correspondence, and documentation.  In addition, the individual will conduct retrospective review of inpatient/outpatient cases and reviews as needed, with supervisors or medical directors. 

Individuals will share after hours and weekend on-call responsibilities. Site visits to providers or to facilities to attend team meetings to assist in developing relationships
and safe, effective alternative service settings may be required.  Performs other duties and special projects as assigned.


Minimum Education:         

Master’s prepared mental health clinician (LMSW, LCSW,LMHC), or licensed Registered Nurse (RN).

New York State licensure required with previous mental health or substance abuse experience.  

Minimum Experience:  

Minimum of 3 years of clinical mental health or substance abuse experience required.

UM or Case Management experience in a managed care organization is preferred.

Knowledgeable with diagnosis and procedural coding, Interqual and ASAM guidelines, psychiatric medication management, hospital case management, and related mental health and substance abuse treatment. 

Required Skills:

Capable of independent thinking with excellent problem solving skills.

Strong interpersonal, communication and computer skills with the ability to work in a
team setting.

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

Must demonstrate understanding of clinical and psychosocial issues that may alter
treatment or care plan 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

MVP Health Care is an Affirmative Action/Equal Opportunity Employer (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), 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

Other details

  • Job Family Medical Management/Clinical
  • Pay Type Salary
  • Required Education Bachelor’s Degree
  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America