MetroPlus jobs - 100 jobs

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Salary Range: $55,000.00 - $65,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State and Plan's established guidelines and/or policies and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of information to all staff. The incumbent will also perform special projects. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Audit daily processed claims through random selection based on set criteria. * Document, track, and trend findings per organizational guidelines * Based upon trends, determine ongoing Claims Examiner training needs, and assist in the development of training curriculum. * Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions. * Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations * Assist in the development of Claims policies and procedures * Provide backup for other trainers within the department * Assist in training of new departmental staffs * Assist with the research and resolution of audit appeals * Asist with external/internal regulatory audits * Identify policies or common errors requiring retraining sessions. * Participate in quality projects as required. * Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate claims service management personnel. * Other duties as assigned by senior management Minimum Qualifications * Associate degree required; Bachelor's degree preferred * Minimum of 4 years of experience performing claims quality audits in a NYS-based managed care setting * Expertise in both professional and institutional claims coding, and coding rules required. * Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required. * Strong knowledge of CMS Medicare and NYS regulations required. * Experience in training development and presentation preferred Professional Competencies * Strong organizational, analytical, and oral/written communication skills required. * Proficiency in PC application skills, e.g., excel, word, PowerPoint, etc., * Must be able to follow direction and perform independently according to departmental * Integrity and Trust * Must have excellent interpersonal, verbal, and written communication skills Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

**Join Us in Shaping the Future of Health Care** At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. **Qualifications you'll bring:** + Bachelor's Degree preferred; will consider equivalent experience. + Three years' experience with data analysis and/or health care quality operations. + Possess strong personnel management skills. + Experience with HEDIS, Medicare Stars, and NYSDOH QARR reporting requirements. + Possess strong analytical skills with detailed knowledge of healthcare operations and datasets. + Possess strong problem-solving skills with a keen attention to detail. + Proven ability to work under pressure and manage multiple priorities effectively. + Self-motivated, proactive, and capable of driving initiatives independently. + Excellent communication and collaboration skills across cross-functional teams. + Microsoft SQL. + Interpersonal skills (e.g., partnering, conflict management, mentoring), with strong verbal and written communication skills, and the ability to interact with most levels of business, technical and end users. + Strategic Thinking: Aligns analytics operations with organizational priorities and anticipates future needs. + Influence & Collaboration: Builds strong relationships and fosters cooperation across teams and departments. + Decision-Making: Demonstrates sound judgment and data-driven decision-making under pressure. + Change Leadership: Champions innovation and process improvements, including automation initiatives. + Talent Development: Mentors and develops team members to achieve peak performance. + Accountability: Holds self and team responsible for delivering high-quality, timely results. + Curiosity to foster innovation and pave the way for growth. + Humility to play as a team. + Commitment to being the difference for our customers in every interaction. **Your key responsibilities:** + Lead and execute quality analytics to support organizational excellence. + Manage annual HEDIS data submissions, including completion of the HEDIS Roadmap, audit coordination, and support for the medical record review project. + Oversee data processes and deliverables for regulatory and performance programs. + Collaborate with business, technical, and Data Governance teams to ensure data integrity and availability. + Monitor and enhance data accuracy, reliability, and compliance standards. + Identify and implement process improvements and automation to increase efficiency and reduce technical debt. + Acquire and integrate data as needed to support quality improvement initiatives. + Foster collaboration by encouraging cross-functional teamwork and promoting cooperation across organizational boundaries. + Serve as a trusted partner to internal and external stakeholders, ensuring expectations and requirements are met. + Other duties as assigned by leadership **.** + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Hybrid in Fishkill, Rochester, Schenectady or Tarrytown, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $121,767.00-$161,949.75 **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** .

**Join Us in Shaping the Future of Health Care** At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. **Qualifications you'll bring:** + Twoor more years in a customer service or sales environment, with some experience in the health care industry such as a hospital, medical office, or health insurance company. + An Associate degree or equivalent combination of education and related experience. + The availability to work full-time, virtual with daily local travel (some evening and weekend hours required). + Must have a valid driver's license. + The ability to speak more than one language (for example,English and Bengali, Hindi an/or Spanish). + Curiosity to foster innovation and pave the way for growth. + Humility to play as a team. + Commitment to being the difference for our customers in every interaction. **Your key responsibilities:** + **Spearhead our membership growth initiatives in crucial target areas** by identifying eligible individuals and seamlessly enrolling them in a variety of plans including Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans (D-SNP). + **Conduct both individual and group outreach activities** to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is both seen and felt. Your collaborative efforts alongside our Field Marketing and Community Engagement Representatives will be pivotal in driving growth and visibility in assigned territories. + **Foster positive relationships** with community-based organizations, medical provider partners, and community contacts to develop a robust network within your territory. + **Generate, track, and convert qualified leads** and referrals into MVP customers. + **Lead two monthly events** that highlight our progressive health solutions directly to the communities we serve, strengthening ties and enhancing our brand's impact. + **Navigate the local landscape with required travel** , embracing the opportunity to bring MVP's customer-centric philosophy to life across our footprint. + **Participate in necessary screenings and provide proof of immunization** as part of our commitment to community well-being. + **Demonstrate the dynamic capability** to transport up to 30 lbs. of promotional materials, which play a key role in educating and empowering our customers about their health care choices. + **Contribute to our humble pursuit of excellence by performing various responsibilities** that may arise, reflecting our collective goal of enhancing health care delivery and being the difference for the customer. **Where you'll be:** + Remote with local travel in Herkimer and Oneida Counties. **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $51,395.00-$68,354.75 **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** .

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Salary Range: $65,000.00 - $74,655.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview The Medical Payments and Fee Schedules Analyst will lead the analysis, development, and implementation of payment rates and fee schedules. Collaborate with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for medical services. Conduct financial modeling, impact analyses, and audits to assess variations in reimbursements. Perform research to aid in the development of a base fee schedule. Serve as subject matter expert in all areas of fee schedules, rate reimbursements, and payment methodologies. Facilitate the integration of contract payment terms into the claims processing system and comprehensively understand the downstream impact of loaded rates within the Plan's entire claims reimbursement cycle. Identify, correct, and perform root cause analyses of fee schedule loaded and reimbursement issues. The ideal candidate will have strong analytical skills, a deep understanding of healthcare reimbursement models, and experience in data reporting and analysis. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Lead analysis of medical payment rates and fee schedules. * Oversee and verify accurate loading of fee schedules per provider contracts. * Identify, correct, and perform root cause analysis of fee schedules and reimbursement issues. * Collaborate with departments including Compliance, Claims Operation, Core Configuration, Products, Contracting, Provider Network Relations, and other related areas to ensure fee schedules and claims adjustments are timely and accurately loaded. * Ensure appropriate implementation of fee schedules and reimbursement methodologies as MetroPlusHealth transitions to value-based reimbursement. * Analyze negotiated contracts to confirm that reimbursements align with negotiated intent. * Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates as necessary. * Serves as subject matter expert with all contract implementation for fee schedule, rate reimbursement matters, and payment methodologies. * Lead and oversee rate testing with all impacted teams within the Plan. * Analyze large data sets to identify trends and present findings with actionable recommendations to senior leaderships and other stakeholders. * Collaborate with departments across the MetroPlusHealth organization to continually understand and optimize performance. * Establish and maintain continuing collaboration with multiple departments. Triage and resolve reimbursement issues. * Organize, log and create categorization of issues for long-term resolution and trend analysis. * Create and execute plans for reimbursement projects, including identifying high-volume providers, setting resolution goals and working with internal departments to achieve Key Performance Indicator (KPI). * Access various systems and analytical tools, including SQL, Tableau, Epace, Microsoft Offices to provide solutions to reimbursement issues. * Use various data elements (including the dates of service, provider type, lines of business and servicing locations etc) to validate accuracy of reimbursements. Minimum Qualifications * Bachelor of Science in Business, Finance, Economics, Information Systems, Healthcare Administrations or equivalent. * Minimum 5 years of relevant experience, preferably in a health care environment. * Strong knowledge of CMS, New York State Medicaid, and third-party fee schedules, as well as industry wide payment methodologies, and claims edit policies required. * Proficiency with Microsoft Excel including LOOKUPs, Pivot Table and Macros. * Excellent understanding of contracts, especially in a provider and payer relationship. * Excellent analytical, problem-solving, and communication skills, with the ability to present complex data in an understandable manner. * Ability to translate business process requirements into a production environment. * Strong familiarity with health plan claims/provider billing systems and interdependent applications. * Experience in data and auditing functions. * Experience in developing and improving business processes. * Knowledge of SQL/SAS/Tableau. Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication * Excellent communication and documentation skills * Ability to multi-task * Strong analytical skills and attention to detail * Analytics, problem solving, technical skills and attention to detail are required Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: CASE MANAGEMENT Job Type: Regular Employment Type: Full-Time Salary Range: $155,000.00 - $170,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview Under the supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible ("IB-Dual") populations, also known as the Medicare dual eligible special needs plan (D-SNP) line of business. This role ensures adherence to the Medicare Model of Care, CMS regulatory requirements, established policies and workflows. They are also responsible for managing the day-to-day operations of the clinical and non-clinical staff, ensuring adherence to the care management process. Most broadly, the Director ensures members are receiving the care they need and that staff are addressing the members' medical, behavioral and social needs while ensuring appropriate linkages in order for them to remain safely in the community. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Participates in the development of the vision and strategic direction for Integrated Care Management; collaborates on the implementation of related strategies. * Supervises, plans, organizes, prioritizes, delegates, and evaluates staff and functions of the Integrated Care Management Department and Medicare line of business. * Ensure staff are care managing members in accordance with the risk stratification identified and adhering to the care management process of screening, assessing, implementing, and evaluating. * Participates in development, implementation, and annual review of the Integrated Care Management and Quality Management/Quality Improvement Plan. * Provides oversight for the implementation and adherence to the Model of Care * Ensures compliance with Federal, State and City regulations as they relate to Medicare, Medicaid, and Health Homes. * Provides oversight for Transitions of Care Process and tracking, implementing strategies to prevent readmissions and reduce hospitalizations. * Collaborates with NYC H+H and external partners on various initiatives, projects and pilot programs. * Gathers, develops and tracks data on evidence-based practice interventions. * Represents ICM at various meetings and committees as required. * Provides clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department, and collaborates with Quality Management on HEDIS, STAR ratings and CAHPS score improvement initiatives and strategies. * Collaborates with the UM Department to manage appropriate member utilization and works with data analytics to generate reports that will illustrate the impact on members' utilization. * Drives the implementation of processes and functional enhancements which will improve the overall quality and services provided by the CM teams. * Collaborate with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner. * Analyzes trends and implements departmental initiatives based upon data provided through the reporting of Care Management or from Quality, Data Analytics and Audit data. * Ensures comprehensive and supportive on-boarding of new hires and effective, data-driven monitoring/coaching to ensure that efficiency and performance are maximized among existing staff. * Maintains communication with the department head, offering routine updates on operations, issues, concerns, and other pertinent information. * Adheres to hybrid work model and provides staff oversight on office days. * Performs other duties as assigned by the Senior Director. Minimum Qualifications * Bachelor of Science in Nursing required. Master's Degree in Nursing preferred. * Minimum 10 years professional healthcare management * Minimum 5 years in leadership role, Manager and above * A minimum of 5 years of administrative experience with supervision of clinical and ancillary staff in a Managed care role required * Must be familiar with OMH, DOH, CMS regulations for service delivery, with a care coordination approach to service delivery in managed care settings Licensure and/or Certification Required: * Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED). Professional Competencies: * Integrity and Trust * Leadership and Management Skills * Customer Focus * Functional / Technical skills * Written/ Oral Communication * Ability to successfully multi-task while under strict timetable * Exceptional Organizational skills Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: CORPORATE TRANSPORTATION Job Type: Regular Employment Type: Full-Time Work Arrangement: Field Salary Range: $51,000.00 - $51,000.00 Reporting to the Corporate Transportation Supervisor, the Support Driver is responsible for operating and maintaining company vehicles. The Support Driver will primarily provide support to all aspects of the Sales and Customer Success Departments' outreach and enrollment efforts - including, but not limited to daily Sales events and promotional activities. In addition, the Support Driver will support all MetroPlusHealth Departments as it relates to special requests and activities. Scope of Role & Responsibilities (URAC Core 25d) Material/Supply Administration and Outreach/Promotional Support * To deliver and distribute marketing materials, supplies and equipment as needed to Sales Representatives, Customer Success Specialists, Supervisors, and Managers at various sites. * Load and unload supplies at point of pick-up, delivery, and distribution. * Assist Sales Representatives, Customer Success Specialists, Supervisors, and Managers in setting up/breaking down equipment at events. Vehicle Use and Maintenance * Complete trip log form whenever using the vehicle. Record mileage in and out. Record all purchases of gas on the log form. * Take vehicle for necessary oil changes, service, and inspection as directed by the Assistant Director. * Maintain the upkeep of the company vehicle with gas, and car washes as necessary. * Maintain awareness of vehicle registration, permits, and insurance dates and deadlines. * Safeguard equipment within the vehicle. * Report any vehicle malfunctions, accidents, loss of vehicle identification or gas card in a timely fashion. * Vehicle identification or gas card cannot be utilized for personal use at any time for any reason. Transportation * Transport staff as needed upon request and authorization to work related meetings or special activities * Lending support to corporate initiatives (i.e.: Holiday Events, Provider Galas, Leadership Conferences), * Receiving and stocking inventory and supplies for the Sales and Customer Success Departments. Other * Assist Sales, Customer Success, and Marketing staff during routine sales outreach (operate popcorn machine, tents, gazebos, distribution of marketing collateral, etc.) * Assist at events (weekday and weekend), as well as other necessary after-hours activities as required. * Conducting outreach efforts as required * Report any changes in license status in a timely fashion license. * Maintain excellent working relationship with mailroom staff, facility loading dock/receiving personnel and warehouse staff. * Other various duties as determined by the Corporate Transportation Supervisor and Fleet Coordinator * Participation in training workshops and conferences that support the goals and objectives of the MetroPlusHealth Growth Division * Complete vehicle stock and equipment inspections and replenishment forms weekly and more frequently as needed * Arrange for the re-stock of marketing materials and promotional items to ensure minimal levels are maintained to support growth and retention efforts Required Education, Training & Professional Experience (URAC Core 25a) * A High School Diploma or equivalent is required. * Ability to operate a Motor Vehicle. * Knowledge of City parking rules and regulations preferred. * Must be able to work evenings, weekends, and flexible hours. Licensure and/or Certification Required (URAC Core 25a) * Must have a valid NYS Driver's License and maintain throughout employment. Professional Competencies (URAC Core 25a) * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication

**Join Us in Shaping the Future of Health Care** At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. The Junior Quality Engineer is a critical part of this transformation. As a member of a Scrum team, the Junior Quality Engineer is primarily responsible for ensuring that 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 candidate is a highly motivated, self-starter who is passionate about quality assurance and can work effectively in an agile environment to ensure commitments are met. The engineer also serves as a role model on the Scrum team to promote quality, innovative, and scalable solutions. **The role includes but is not limited to the following:** + Working with Quality Assurance leaders and team leads to implement process improvement initiatives that drive improved quality and accuracy while promoting industry best practices. Leverage DevOps concepts to promote good quality and automation practices + Follow best practices and test strategies utilizing industry standard testing techniques and methodologies. Execute master test plans for large scale projects + Participate in Agile defect management process. Ensure quality solutions are delivered to the business by executing a strategic and well-planned test approach. Create detailed, comprehensive, well-structured test cases that are automatable. Create system or business process flow diagrams + Utilize structured query language (SQL) for data mining and data seeding purposes. Identify critical path regression scenarios. Conduct root cause analysis and participate in debugging activities + Ensure proper test coverage by utilizing a traceability matrix. Participates in release/sprint planning activities and daily stand-up meetings. Participates in user story creation, backlog refinement scrum ceremonies ensuring appropriate test acceptance criteria, test cases, and test plans are in place + Provide story points estimates for quality deliverable portion of a user story + Provide estimates for quality assurance tasks being performed for user stories. Accountable for regular status updates to all assigned sprint tasks during daily stand-up meetings **Technologies:** One or more of the following preferred: Python, SQL, T-SQL, SSIS, SSRS, and SSAS **Qualifications** **Education:** Bachelor's degree in Computer Science or related field/relevant work experience required. + 1 year experience working in an agile environment. Experience in DevOps concepts preferred. Ability to problem solve and implement solutions. + Command of the software development lifecycle (SDLC). Understanding of testing methodologies and techniques Experience with test automation and tools + Highly self-motivated and directed with the ability and dedication to meeting aggressive deadlines while ensuring quality delivery. Experience with test case design, test scripts, test execution and defect management preferred. Familiarity with structured query language (SQL), Python or other coding language. + Ability to understand and embrace our SDLC, business processes, and strategy. Understanding of Agile Development Methodology (SCRUM, Kanban) + Strong written and verbal communication skills with the ability to communicate effectively with technical and non-technical team members and customers **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $51,395.00-$68,354.75 **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** .

Department: CASE MANAGEMENT Job Type: Regular Employment Type: Full-Time Salary Range: $85,000.00 - $85,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview The primary goal of the Care Manager is to optimize members' health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member's needs, environment, providers, support system and optimization of services available to them. The Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. The Care Manager is monitored and assessed based on value added to improved health status of member. That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager's primary role is to support members in need and problem solve issues in a beneficial manner for the member and Plan. The support is comprehensive and includes clinical, social, financial, environmental and safety aspects. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Physically meet the members where they are to gain deep understanding of their situation and needs * Problem solves member's problems and needs: clinical, psychosocial, financial, environmental * Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation * Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being * Assess risks and gaps in care * Maximize member's access to available resources * Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices * Communicate plan of care to Primary Care Physician initially and no less than monthly with updates * Ensure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques * Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc. * Provide Complex care management including but not limited to; insuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports * Advocate for members by assisting them to address challenges, and make informed choices regarding clinical status and treatment options * Develop collaborative relationships with clinical providers and facility staff * Employ critical thinking and judgment when dealing with unplanned issues * Ability to use data as a tool in tracking and trending outcomes and clinical information * Maintain accurate, comprehensive, and current clinical and non-clinical documents * Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures, and actively participate in evaluation process * Maintain professional competencies as a Care Manager * Other duties as assigned by Team Lead and Manager. Minimum Qualifications * Master's Degree required * LMSW/LCSW with current NYS license * Minimum 3 years' prior experience in Case Management in a health care and/or Managed Care setting strongly preferred * Proficiency with computers navigating in multiple systems and web-based applications * Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required * Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies * Ability to work closely with member and caregiver. * Integrity and Trust * Customer Focus * Functional/Technical Skills * Written/Oral Communications * Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive * Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities * Time management and organizational skills * Strong problem-solving skills * Ability to prioritize and manage changing priorities under pressure * Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. * Ability to form effective working relationships with a wide range of individuals #LI-Hybrid #MPH50 Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs

**Join Us in Shaping the Future of Health Care** At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. **Qualifications you'll bring:** + Must be enrolled in a Computer Science, Information Systems, or a technically equivalent undergraduate degree program or equivalent military experience. + Basic hardware + Windows 10\11 + Office365 + Software skills + Troubleshooting skills. + Ability to multi-task and work within time constraints. + Ability to work collaboratively. + Critical thinking + Problem-solving skills. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Installation and maintenance of personal computers and including all peripheral equipment. + Installation and configuration of personal computers and printers (network and desktop). + Diagnosing computer and network problems on-site or by assisting help desk staff with user telephone consultations. + Upgrading of computers and peripheral equipment. + Receipt and distribution of new computer equipment. + Tests new operating systems and software titles for interoperability and functionality with existing systems and software. + Good knowledge of modern personal computers and local area networks. + Good knowledge of installation procedures relating to personal computers, local area networks, peripheral equipment and software. + Ability to install office computer systems. + Ability to work with remote users with different remote tools. + May perform other related duties as required. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Location: Onsite; Schenectady, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $0.00-$0.00 **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** .

SIGN ON BONUS!!! Job Title: Ultrasound Technologist Reports To: Chief Operating Officer Department Radiology FLSA Status: Non-Exempt Salary Range: $45-$56/hr At East River Medical Imaging, our mission is to consistently provide the highest quality and availability of diagnostic imaging with compassion and comfort for our patients. Each of our physicians is certified by the American Board of Radiology. Together, they represent all areas of sub-specialty medical imaging, including cross-sectional, musculoskeletal, oncologic and neuroradiology. We are currently seeking a full-time Scheduler to join our team. The incumbent will produce two dimensional ultrasonic recordings of internal organs for use by Physician in diagnosis of disease and study of malfunction of organs by performing the following duties. Duties Selects equipment for use in ultrasound setup according to specifications of examination. Explains process to patient, and instructs and assists patient in assuming physical position for examination. Selects transducer and adjusts equipment controls according to organ to be examined, depth of field, and other specifications of test. Keys test data and patient information into computer of ultrasound equipment to maintain record of test results. Moves transducer, by hand, over specified area of body and observes sound wave display screen to monitor quality of ultrasonic pattern produced. Starts equipment which produces images of internal organs and records diagnostic data on magnetic tape, computer disk, strip printout, or film. Photographs images of organs shown on display module, or removes strip printout from equipment, to obtain permanent record of internal examination. Selects equipment for use in ultrasound setup according to specifications of examination. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Certificate from a valid ultrasound diagnostic program (min. 9 month program) and ARDMS ABD and/or OB/GYN Competencies: To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Language Ability: Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Math Ability: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Computer Skills: To perform this job successfully, an individual should have knowledge of MS Office word processing software. Certificates and Licenses: Ultrasound specialty training certification (ARDMS), active BLS training. Supervisory Responsibilities: This job has no supervisory responsibilities. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently exposed to work near moving mechanical parts. The employee is occasionally exposed to fumes or airborne particles; risk of electrical shock and risk of radiation. The noise level in the work environment is usually moderate. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include Close vision, Distance vision, Peripheral vision, Depth perception and Ability to adjust focus. While performing the duties of this Job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stoop, kneel, crouch, or crawl. The employee is occasionally required to sit; climb or balance and taste or smell. The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Join Us in Shaping the Future of Health CareAt MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What's in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.About the Opportunity As a Broker Engagement Leader you will be responsible for assisting your team build and maintain strong relationships with brokers for all lines of business. What You'll Do Assist in managing and maintaining relationships with brokers, ensuring effective communication and timely resolution of any issues. Support your team with the onboarding process for new brokers, including gathering necessary documentation and coordinating with internal stakeholders. Collaborate with cross-functional teams to ensure seamless integration of broker administration processes with other business functions. Stay updated on industry trends and best practices related to broker engagement and share knowledge with the team. Identify possible new business solutions Work with your team to provide brokers with product knowledge (when necessary), updates on company policy, and training on best practices to optimize MVP Client Servicing. Management & cultivate relationships with our brokers through regular communication and strategic communication. Other duties as assigned by leadership. Skills and Experience Education, Licensures, & Certifications Bachelor's degree in business administration, finance, or a related field. Years of Experience (Required & Preferred) Proven experience in broker administration or a similar role. Required Job Skills Strong analytical skills with the ability to interpret data and provide actionable insights. Excellent communication and interpersonal skills to effectively collaborate with brokers and internal stakeholders. Detail-oriented with strong organizational skills to manage multiple tasks and prioritize effectively. Proficient in using Microsoft Office Suite, particularly Excel, for data analysis and reporting. Preferred Job Skills Knowledge of the insurance industry and broker management systems is a plus. Worksite Designation Hybrid in Rochester or Schenectady, NY Pay TransparencyMVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.We do not request current or historical salary information from candidates. $69,383.00-$92,279.00MVP's Inclusion StatementAt MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ...@mvphealthcare.com .

Department: Provider Network Operations Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $100,000.00 - $116,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level administrators at each assigned network facility and community providers. Responsible for overall provider satisfaction regarding assigned network segment and will manage respective network support team. Duties & Responsibilities * Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting assigned network segment. * Responsible for day-to-day business activities and managing provider relationships. * Cultivate strong partnership with assigned network facility and community providers. * Develop and implement educational processes and pro-active solutions for payment and other provider operations requirements as well as access & availability concerns * Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results. * Ensure segment's data integrity of provider directory, web search, etc., * Monitor/Trend Provider calls received as well as any complaints received for responsible segment * Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures. * Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment. * Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate * Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues * Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase MetroPlusHealth enrollment and retention efforts. * Coordinate events with the community/government agency offices within assigned network * Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes. * Attend Joint Operating Committee meetings and takes ownership of resolving issus with assigned hospitals, etc. * Develops policies and procedures, process improvement initiatives * Manage and mentor staff to ensure job functions are completed appropriately and according to priorities * Coordinates department's efforts with those of other departments * Performs other support activites and duties as assigned Minimum Qualifications * Bachelor's degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area. * Master's degree in Health Administration preferred * Strong customer service experience with proven ability to build and maintain provider relationships * Managed care, value-baed payment model, quality and population health management experience * Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel * Proficiency with Windows-based PC systems and Microsoft Office, Sharepoint * Ability to travel to meet with Providers and their representatives Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Excellent written and communication skills; ability to deliver complex information and achieve positive results * Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals. * Strong problem-solving capabilities * Highly organized, detail oriented, dependable and professional individual #LI-HYBRID #MPH-50

**Join Us in Shaping the Future of Health Care** At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work For in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** . You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. **Qualifications you'll bring:** + Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered. + Coding certification, such as AAPC CPC, CIC, COC, CCS is required. + The availability to work full-time, virtual in New York State + A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience. + Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies. + Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details. + Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Manage recurring audit inventories, ensuring timely progression and completion of existing audits. + Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews. + Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types. + Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education. + Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization. + Assist in the reporting of monthly metrics and participate in cross-functional audit operations. + Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts. + Participate in training and development activities within the department and corporation. + Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. + Perform research using "best practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual within New York State **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $69,383.00-$92,279.00 **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** .

SIGN ON BONUS!!! Job Title: DEXA Technologist Reports To: Radiology Director & Radiology Administration Director Department: Radiology FLSA Status: Non-Exempt FULL TIME and PART TIME POSITIONS AVAILABLE Salary:$40-$44 Summary: At East River Medical Imaging, our mission is to consistently provide the highest quality and availability of diagnostic imaging with compassion and comfort for our patients. Each of our physicians is certified by the American Board of Radiology. Together, they represent all areas of sub-specialty medical imaging, including cross-sectional, musculoskeletal, oncologic and neuroradiology. We are currently seeking a full-time DEXA Technologist to facilitate ERMI s patient treatment and care objectives by performing radiographic/DEXA procedures. ERMI s DEXA Technologists are imperative to our practice, assisting physicians in the diagnosis of disease and injuries by performing the following duties. Duties Prepare and position patients for DEXA diagnostic imaging procedures. Prepare equipment prior to use, ensuring it is clean and set up properly. Adjust immobilization devices to obtain optimum views of specified area of body requested by physician. Explain procedures to patients, aiming to reduce anxieties and encourage patient cooperation. Move imaging equipment into specified position, determine exposure factors on basis of height, weight, portion of body involved, and degree of penetration required, and adjust equipment controls to set exposure factors and produce images of proper detail, density, and accuracy. Practice radiation protection techniques to minimize radiation exposure to patients and staff. Perform specialized and routine diagnostic radiology procedures, including nuclear medicine and sonography. Independently implements patient procedures in accordance with departmental protocols and standards. Properly maintains equipment and medical tools, inspecting for cleanliness and working order. Maintain accurate patient records and log sheets. Assist in completion of reports and data collection/reporting. Competencies: To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Skills: Strong working knowledge of Microsoft Office Excellent project and time management skills Ability to work with minimal supervision while understanding the need for communicating and coordinating work efforts with other employees. Strong work ethic and emphasis on attention to detail. Excellent customer service, communication, and organization skills. Working knowledge patient privacy and HIPAA protection of data, information, and other relevant medical policies Ability to derive practical solutions independently in a fast-paced environment and can address patient care issues appropriately. Working knowledge of medical terminology. Experience in collecting, analyzing, and presenting data. Working knowledge of DEXA equipment and radiography. Working knowledge of radiology safety procedures, especially regarding radiation health and safety. Language Ability: Ability to read, analyze and interpret general business periodicals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Bilingual applicants are encouraged to apply. Math Ability: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Computer Skills: To perform this job successfully, an individual should have knowledge of MS Outlook, MS Word, word processing software; MS Excel spreadsheet software; and database software. Experience using digital medical record software and PACS/RIS/Royal systems a plus Certificates and Licenses: New York Radiologic Technologist License required. Supervisory Responsibilities: No applicable advisory responsibilities pertaining to this role. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include Close vision and Ability to adjust focus. While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Department: Provider Network Operations Job Type: Regular Employment Type: Full-Time Salary Range: $50,000.00 - $59,948.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Responsible for providing provider onboarding, training for claims and billing procedures, contract compliance, Product, medical management, and pharmacy issues. Promotes provider compliance with local/state/region/federal regulations through provider forums and training opportunities, inclusive of behavioral health network. Duties & Responsbilities * Provide provider onboarding along with any on-going trainings either at provider sites or remotely. * Organize training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc. * Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy. * Develops and provides a standard orientation package for newly contracted providers. * Promotes technology and skills development to improve provider business practices. * Implement processes for documenting and monitoring training program for provider compliance and program effectiveness. * Ensure contract compliance and identify areas for improvement. * Participate in cross functional teams to solve system issues. * Other duties as required and assigned by management. Minimum Qualifications * Bachelors' Degree required, preferably in health care administration, marketing, or a related area of study; and * 3-5 years' of experience in a managed care or provider organization; or * A satisfactory equivalent combination of training, education, and experience performing provider training/education or work in a related field * Experience in behavioral health field, preferred. * Ability to travel within the MetroPlusHealth service area to meet with providers and their representatives * Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation * Highly organized, detail oriented, dependable and professional individual * Ability to exercise tact and diplomacy and demonstrate strong customer service skills * Ability to prepare written and oral reports and make effective presentations #LI-HYBRID #MPH-50

Join Us in Shaping the Future of Health CareAt MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What's in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.The engineer works with business and technology partners to deliver software solutions to support the business. The engineer also serves as a role model and technical lead on the Scrum teams to promote quality, innovative, and scalable solution delivery.The role includes but is not limited to the following: Must be able to develop quality software solutions for the business Complete code reviews for members of the scrum team Engage in scoping and estimating processes to support roadmap and planning efforts Participate in backlog refinement, grooming activities, and Scrum ceremonies Work closely with key stakeholders in designing solutions Contribute to all development efforts of the Scrum team Work with Product Owners and Scrum Masters in understanding backlog Participate in code reviews Utilize Scrum best practices and processes to deliver quality work and on-time delivery Exhibit self-motivation to proactively drive a task or initiative to completion Position QualificationsMinimum Education:Bachelor's Degree in Computer Science or related field or relevant work experience.Minimum Experience:1+ years' experience in software application development or related education1+ years' experience in an Agile environment Experience in test driven development preferred Experience supporting Agile planning and work estimation Must Have:.NET development experience Relational SQL-based database experience Front end development with a framework, such as React, Knockout or AngularWorked within an agile environment One or more of the following preferred: Experience with Git React Azure Microsoft Dynamics Informatica SSIS SSRS Knowledge of the healthcare industry Experience in DevOps Test Driven Development Required Skills: Ability to problem-solve and implement solutions Command of standard development/SDLC Highly self-motivated and directed with the ability and dedication to meeting aggressive deadlines while ensuring quality delivery Pay TransparencyMVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.We do not request current or historical salary information from candidates. $69,383.00-$92,279.00MVP's Inclusion StatementAt MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ...@mvphealthcare.com .

**Covid-19 Vaccination Required** Job Title: XRAY Technologist Reports To: Director of Radiology & Administrative Director of Radiology Department Radiology FLSA Status: Non-Exempt Location: NYC and Westchester Salary Range: $40-$44/hr SIGN ON BONUS!!! Summary: Performs radiographic X-ray procedures to assist physicians in the diagnosis of disease and injuries by performing the following duties. Duties Prepares and positions patient for diagnostic imaging procedures. Adjusts immobilization devices to obtain optimum views of specified area of body requested by physician. Explains procedures to patient to reduce anxieties and obtain patient cooperation. Moves imaging equipment into specified position, determines exposure factors on basis of height, weight, portion of body involved, and degree of penetration required, and adjusts equipment controls to set exposure factors and produce images of proper detail, density, and accuracy. Practices radiation protection techniques to minimize radiation to patient and staff. Performs specialized and routine diagnostic radiology procedures, including nuclear medicine and sonography. Competencies: To perform the job successfully, an individual should demonstrate the following competencies: Problem Solving: Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. Customer Service: Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Adaptability/Dependability: Follows instructions, responds to management direction; Accepts criticism and feedback; Adapts to changes in the work environment; Changes approach or method to best fit the situation; Manages competing demands. Commits to doing the best job possible by working the necessary hours to complete assignments; Keeps commitments; Meets attendance and punctuality guidelines; Responds to requests for service and assistance; Takes responsibilities for own actions. Completes tasks on time or notifies appropriate person with an alternate plan. Quality: Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality. Language Ability: Ability to respond to common inquiries, ability to read, write and comprehend instructions, correspondence, and memos. Ability to effectively present information in one-on-one, small and large group situations to customers, clients, and other employees of the organization. Reasoning Ability: Ability to solve practical problems, interpret a variety of instructions furnished in written, oral, diagram, or schedule form and define problems, collect data, establish facts, and draw valid conclusions. Ability to deal with a variety of variables in situations where only limited standardization exists. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Associate's degree or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Skills: Project and time management skills Ability to work with a minimum of supervision while understanding the necessity for communicating and coordinating work efforts with other employees Strong work ethic and emphasis on attention to details Excellent customer service, communication, and organization skills Communicate professionally with patient, physicians, and staff in addition to language ability in the competency section Computer Skills: To perform this job successfully, an individual should have knowledge of MS Suite Certificates and Licenses: Xray specialty training certification (ARRT-R), NYS RT License with Injection, active BLS training. Supervisory Responsibilities: This role has no direct supervisory responsibilities. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently exposed to work near moving mechanical parts. The employee is occasionally exposed to fumes or airborne particles; risk of electrical shock and risk of radiation. The noise level in the work environment is usually moderate. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include Close vision, Distance vision, Peripheral vision, Depth perception and Ability to adjust focus. While performing the duties of this Job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stoop, kneel, crouch, or crawl. The employee is occasionally required to sit; climb or balance and taste or smell. The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. #ZR

Department: MHP PRODUCT Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $90,000.00 - $100,000.00 Reporting to the Vice President of Product, the Product Sepcialist, Materials, ensures operational excellence and regulatory compliance owning the full spectrum of product member materials and across all Product Lines. Scope of Role & Responsibilities * Responsible for all member materials and communications under Product department and Product review. * Ensures timely cadence of required documents allowing needed time for cross-departmental collaboration. * Establishes efficient processes related to regulatory communications with an expertise on Medicare ANOC, EOC, and annual CMS and Sales materials. * Responsible for updating Model Contracts for our QHP/EP and Large group Products adhering to State deadlines. * Collaborate with internal stakeholders and Compliance to ensure all regulatory materials including member handbooks and member/provider communications, are aligned with CMS and State regulations. * Periodic review of benefits posted on MetroPlus member and provider web pages pertinent to all MetroPlus products. * Work closely with Marketing, Regulatory and Compliance to support document creation for internal and external product communication materials. * Establish and manage efficient processes for member material creation, State and CMS approvals, and mailings in compliance with State and CMS timelines. * Update Medicaid materials with regulatory model language for State submission and approval, prior to use. * Partners with the Communications Department for feedback and input on required documents * Works closely with Regulatory department for approval of documents. * Provide oversight vendor operations as they relate to required mailings with printing vendors adhering to vendor guidelines and requirements. Required Education, Training & Professional Experience: * Bachelor's degree from an accredited college or university in an appropriate discipline required. * Master's degree in business, healthcare or public administration strongly preferred. * Minimum 5 years' experience at a Health Plan in a product management or compliance role. * Knowledge of Medicaid and Medicare products and regulatory environment in NYS * Experience with CMS ANOC and EOC and NYS model contracts. * Demonstrated ability to develop and enhance processes, policies, procedures. * Demonstrated ability to identify opportunities for improvement & implement solutions. Professional Competencies: * Leadership * Results-driven * Business acumen * Systems orientation * Process improvement * Data-driven decision-making * Customer focus * Excellent written & verbal communication skills. * Resourcefulness * Ability to work effectively in a fast-paced & constantly evolving environment * Highly collaborative and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making. * Ability to take initiative & think independently * Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values #LI-Hybrid #MHP50

Department: PARTNERSHIP IN CARE Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $55,000.00 - $55,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview: MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. With the support of the PIC Clinical Care Manager, the Health & Wellness Advisor I ensures the promotion of health and wellness among HIV-positive members and other members at high-risk for HIV by conducting high-volume outreach to assess their health and psychosocial needs and support them to stay in care and adherent to medication. The Health & Wellness Advisor I works in conjunction with the PIC Clinical Care Manager and other colleagues in a team-oriented approach with a focus on establishing member rapport. Work Shifts 9:00AM-5:00PM Duties & Responsibilities: * Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for members who are living with HIV, transgender, and homeless. * Performs telephonic care management activities including assessment, plan of care development, care coordination, out-patient follow-up, and ancillary service review to ensure optimum health outcomes. * Develops and implements an individualized, member-centered Plan of Care through direct telephonic and face-to-face member engagement, and inclusion, where appropriate, of collateral contacts including family members (with appropriate consent of the member), primary care provider, and other community and case managers to identify and address the needs and barriers of members living with HIV (and others in the Special Needs Plan) to promote the health and wellness of the member. * Provides health education using coaching and motivational interviewing techniques to promote improved health outcomes for HIV engagement in care and viral load suppression, engagement with behavioral health and substance use services and effective management of other co-morbid illnesses, such as hepatitis C, diabetes, hypertension, and asthma/COPD. * Participates in special outreach and quality improvement projects as assigned. * Documents all care management activities for each member and ensures that such documentation is in compliance with professional standards and regulatory guidelines using the correct templates. * Addresses member primary care provider assignment during outreach and reassigns members as appropriate. * Carefully follows designated departmental compliance, care management, and quality improvement and workflows as assigned. * Escalates cases and issues to their supervisor as appropriate. * Answers calls on the in-bound call center telephone line in a professional and timely manner. * Attends and prepares for case conferences, including Medicare interdisciplinary case conference and conferences on special topics and/or with other departments. * Orients assigned new members to MetroPlusHealth and the scope of services the plan provides as needed. * Ensures that coordination of membership enrolled in all lines of business is compliant with Federal, State, and City regulations, and are consistent with the Mission, Vision, and Values of the organization Minimum Qualifications * Bachelor's degree from an accredited college or university in a healthcare-related field is required. * Master's degree is preferred. * A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and case management. Managed care experience is preferred. Professional Competencies: * Integrity and Trust * Customer Focus * Functional/ Technical Skills * Written/Oral Communications