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  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #329
    Monday, October 21, 2019
    Professional, Case Manager    Status: Full-time, Exempt: Yes        Summary: This position 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 the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, r ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #346
    Friday, October 18, 2019
    This position will lead MVP’s cyber security team. They will be responsible for supporting the information security agenda at MVP, with a focus on risk management, incident response, vulnerability management as well as the creation of security policies, standards and procedures for the protection of information confidentiality, integrity and availability. They will need to balance time between program management, personnel management, and business development activities that enables the team to ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #331
    Tuesday, October 8, 2019
    Status: Full-time, Exempt: Yes SUMMARY:Development and maintenance of data  and formulas in rating tools. Lead on implementation of new tools and rating methodologies, including vendor communication. Ad hoc reporting as needed from both underwriting systems and companywide data  sources. Works with Actuarial to ensure updates to filings are implemented and tested  in quoting tools.  Works with FP&A to develop pricing for ancillary and ASO products. Provides training and assistance on data  rep ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #323
    Monday, October 7, 2019
    Status: Full-time, Exempt       Reporting to the Sr. Leader, Claims Payment Strategies and Configuration, the Leader, Pricing & Claims Configuration manages the design, development and implementation of configuration solutions that enhance business processes. The Leader supervises a staff of Professional Configuration Analysts and manages the work intake, prioritization, assignment and tracking of all pricing/claims configuration projects and requests. In addition, the Leader is responsible to ... More
  • Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA
    Req #318
    Tuesday, October 1, 2019
    Associate, Outreach Representative - Mid-Hudson Area  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 Qualifi ... 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 #321
    Monday, September 30, 2019
    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 to improve clinical outcomes across all business ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #246
    Monday, September 30, 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 initiating cases for revi ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #313
    Monday, September 30, 2019
    Professional, IT Governance & SharePoint AnalystBe 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. IT & 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 te ... More
  • 5455, 303 S Broadway # 321, Tarrytown, NY 10591, USA
    Req #297
    Tuesday, September 24, 2019
    This position is a critical role within MVP, supporting the successful transition of our participating providers to Value-Based Payment (VBP) and the achievement of the triple aim. PHMP professionals will be assigned to support the Regional VBP Leaders and the management of relationships and VBP contracting efforts with MVP’s strategic provider network partners in order to realize quality goals; support care coordination of patients; address social determinants of health; support integration of ... 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 #303
    Monday, September 23, 2019
    Full-Time, Exempt Summary: This role will work closely with all departments implementing and ensuring the CRM tool-set works effectively across teams while maximizing efficiency and capitalizing on the full features and benefits of the Dynamics platform. Participate in planning, organizing and management of all CRM applications projects to ensure effective operations. Monitor CRM processes, resolving issues that arise in the execution of campaigns & workflows. Identify areas for improvemen ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #292
    Friday, September 20, 2019
    Professional, Client Support       Summary: This position serves to provide day-to-day support to the commercial large group sales and account management team. Specific responsibilities include: daily sales, renewal, and administrative support for large group new sales and client engagement teams, proposal support, rate quote preparation, assistance with preparing reports and presentation material. Resolution, including monitoring and tracking, of broker and client issue ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #295
    Monday, September 16, 2019
    Status: Full-time, Non-Exempt          Summary: Responsible for processing all aspects of Medicaid, Child Health Plus and HARP enrollment into core systems with a strong attention to detail. Process enrollments, changes and terminations from rosters, email correspondence and electronic data sources. Process error reporting and system reconciliation files. Respond to eligibility inquiries for both internal and external customers. Serve as a team ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #289
    Friday, September 13, 2019
    Status: Full-time, Exempt: Yes  Provides data analysis and projected utilization and costs for all lines of business and sub-groupings in aggregate for appropriate action. Performs monthly analysis of actual utilization and cost trends and compares/adjusts projected rates. Performs quarterly data pulls for rebate submissions and reconciliations. Evaluates and identifies inappropriate prescribing patterns from prescription and medical claims data for potential action by appropriate personnel. Co ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #282
    Friday, September 6, 2019
    Band Level: Professional II    Status: Full-time, Exempt Referral Bonus: Standard Talent Acquisition Representative: Jan Cozzy, jcozzy@mvphealthcare.comThis role will work closely with all departments implementing and ensuring the core system works effectively across teams while maximizing efficiency and capitalizing on the full features and benefits of the platform. Participate in planning, organizing and management of all core system projects to ensure effective operations. Monitor cor ... More
  • Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #283
    Thursday, September 5, 2019
    Nonexempt / Part time JOB SUMMARY:Under the direction of the Executive Assistant, IT&TS / CIO:Performs administrative duties for IT leadership team as well as provides general administrative support to the entire IT&TS department across three offices (onsite support of Rochester staff, remote support of Schenectady and Tarrytown staff as needed).  Schedule management for department leaders, scheduling and coordination of onsite and offsite meetings. Screen vendor inquiries as an aide to departme ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #274
    Tuesday, September 3, 2019
    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 #271
    Thursday, August 29, 2019
    Status: Full-time, Exempt     This role works with the CRM staff, Marketing & Communications, Business Areas, and the IT Development team to develop the training program for specific CRM initiatives and applications. This position will design, write, and develop instructor-led and technology delivered courses using content developmental tools and will work with business experts to refine course content based on process and training needs, while meeting MVP brand and communication standards. The ... More
  • Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA
    Req #145
    Thursday, August 29, 2019
    Associate, Provider Based Outreach Representative    The Outreach Representative conducts provider based 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 (QHPs), insu ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #264
    Friday, August 23, 2019
    Intern – Operations, Hourly   The CRM Intern will support the implementation of a new CRM solution at MVP.  The project will focus on researching, validating and assembling a proposed business plan focused on addressing and rationalizing digital servicing and engagement capabilities within our CRM program for MVP prospects and members.  The project will study and assemble recommendations for self-service capabilities and value-added content and functions for our member portal and mobile (inclu ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #106
    Thursday, August 22, 2019
    Status: Fall Intern, Part time    Location: Tarrytown, NY        The intern will be responsible for assisting the Medicaid Strategic Business Unit with day-to-day activities to ensure organizational compliance with all Medicaid and Child Health Plus contract requirements and State, Federal and local rules and regulations. Provide departmental support to ensure SBU programs and projects meet organization goals and requirements Responsibilities include document ... More
  • Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #236
    Tuesday, August 13, 2019
     SUMMARY: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 renewed agreements in a manner nee ... More
  • 220 Alexander St, Rochester, NY 14607, USA; 625 State St, Schenectady, NY 12305, USA
    Req #88
    Tuesday, August 13, 2019
    Software EngineerBe 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 tr ... 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 #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, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    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, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    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