Job Search

Loading...
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    Req #366
    Wednesday, October 30, 2019
    RESPONSIBILITIES:Review and integrate medical information from diverse sources including medicalrecords, immunization registries, member documents, and provider offices.Request and abstract appropriate medical records, assessing for assignedcategories as needed. Review assigned medical records in order to abstractspecified and required clinical data elements for HEDIS reporting. Participatein medical record collection and inter-rater reliability process. Schedule andperform on-site medical recor ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #360
    Wednesday, October 30, 2019
    Status: Full-time, Exempt: Yes SummaryThis role is responsible for monthly investment processing, reporting and reconciliation; preparation of investment schedules for NAIC quarterly and annual filings;  processing  electronic funds transfers and preparing daily cash  position reports and forecasts; preparation and review of monthly bank reconciliations; assisting with system upgrades; assisting with internal and external audits;  implementing policies and procedures;  performing  other duties ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #301
    Friday, October 25, 2019
    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 #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. This is including, but not limited to: calling providers, members, and pharmacies; having knowledge of pharmacy benefits for MVP’s multiple lines of business, formularies, and policies; providing drug-related information to Customer Care Center and other internal departments; managing incoming faxes requesting drug coverage; determining el ... 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
  • 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; 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
    Status: Full-time, Exempt     The Systems Enablement role will work closely with all departmentsimplementing and ensuring MVP Health Care’s new core system works effectivelyacross teams, while maximizing efficiency and capitalizing on the full featuresand benefits of the platform. Reporting to the Leader, Core Systems, thisindividual will participate in planning, organizing and management of all coresystem projects to ensure effective operations. They will monitor core systemprocesses, supportin ... 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
  • 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
  • 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
  • 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
  • 625 State St, Schenectady, NY 12305, USA
    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
  • Headquarters Office, 625 State Street, Schenectady, NY, USA; Rochester Office, 220 Alexander Street, Rochester, NY, USA
    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
  • 220 Alexander St, Rochester, NY 14607, USA; 625 State St, Schenectady, NY 12305, USA
    Req #124
    Monday, June 17, 2019
      Summary: Be a part of the transformation at MVP Health Care. Information Technology & 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 technology to grow our business. The role has an essential role in our transformation to a service-optimized IT organization.    This position will support Department goals of implementing modern platforms for the enterprise while ... More
  • 625 State St, Schenectady, NY 12305, USA
    Req #114
    Monday, June 17, 2019
    Status: Full-time, Exempt           Summary: The role will be responsible for driving the successful activation and adoption of Dynamics365 CRM throughout the enterprise – this will be achieved by acting as the hero/ambassador/champion/coach for MVP departments and stakeholders; executing on-point and pertinent training, coaching and advocacy by ultimately immersing yourself into the end-user’s world.  With a direct focus on usage, adoption and evolvi ... More
  • Headquarters Office, 625 State Street, Schenectady, NY, USA
    Req #102
    Thursday, June 13, 2019
    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 sources (hospitals ... More
  • Rochester Office, 220 Alexander Street, Rochester, NY, USA; Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA
    Req #98
    Wednesday, June 12, 2019
    Professional, Transition Case Manager - BH     Status: Full-time, Exempt: Yes         Summary: This role will provide support to MVP members who are at risk for behavioral health or substance use readmission. MVP’s Transition Care team will outreach members during hospitalizations/rehabilitation and post discharge, to assist them in overcoming major “barriers to care”. This coaching is done through a variety of methods such as home visits and tel ... More