Case Manager jobs at MVP Health Care

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a **Case Manager, Medicaid Long Term Support Program** to join #TeamMVP. If you have a passion for advocacy, collaboration and problem solving and innovation this is the opportunity for you. **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 and one of the **Best Companies to Work For in New York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home required. + Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations. + 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:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, coordination of care and resource allocation. + The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. + The position will provide guidance in understanding benefit coverage and navigating the health care delivery system. + The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of LTSS services. + Care Coordination: Collaborate with case managers, care coordinators, and providers to ensure integrated, person-centered care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (e.g., NCQA), including documentation and reporting. + Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution. + Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines. + 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:** This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown). **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. **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 ******************** . **Job Details** **Job Family** **Medical Management/Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD** **Hiring Max Rate** **102,350 USD**

Licensed Behavioral Health Clinicians provide supportive counseling, advocacy, education, and care management to help patients and their families navigate mental illness, access community resources, and manage symptoms to help them remain safely inthe community This is a senior, master's level, licensed social services role that provides direct care as part of a team. Join us in building on our 130-year history and become a part of the Future of Care that is strengthening communities with high quality, integrated behavioral health programs.VNS Health Behavioral Health team members provide vital client-centered behavioral health care to New Yorkers most in need, across all stages of life and mental well-being. We deliver care wherever our clients are, including outpatient clinics, clients' homes, and the community. Our short- and long-term service models include acute, transitional, and intensive care management programs that impact the most vulnerable populations, from children, to adolescents, to aging adults. As part of our fast-growing Behavioral Health team, you'll have an opportunity to develop and advance your skills, whether you're early in your career or an experienced professional. What We Provide Attractive sign-on bonus and referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, CEU credits, and advancement opportunities Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals What You Will Do Utilizes approved assessments to identify clients/members needs and family needs; develops initial and ongoing clinical plan of care. Updates plan at specified intervals, and as needed based on changes in client/member condition or circumstances Performs and maintains effective care management for assigned caseload of clients/members. Leads the care coordination for complex psychiatric clinical cases. Tracks and monitors progress; maintains detailed, accurate and timely progress notes and other documentation Provides supportive counseling and/or supportive therapy as well as ongoing mental health services Collaborates and refers to appropriate agencies as required. Addresses any client/member concerns to ensure satisfaction with overall services provided and uses motivational interviewing techniques to foster behavioral changes Develops inventory of resources that meet the clients/members needs as identified in the assessment Provides linkage, coordination with, referral to and follow-up with appropriate service providers and managed care plans. Facilitates periodic case record reviews and case conferences with all providers serving the clients/members Provides information and assistance through advocacy and education to clients/members and family on availability and eligibility of entitlements and community services. Arranges transportation and accompanies clients/members to appointments as necessary Assists clients/members and/or families in the development of a sustainable network of community-based supports, utilizing identified strengths and tools designed to prevent future participant crises and/or reduce the negative impact if a crisis does occur Participates in initial and ongoing trainings as necessary to maintain and enhance clinical and professional skills Maintains updated case records in program EMR. Maintains case records in accordance with program policies/procedures, VNS Health standards and regulatory requirements Participates and consults with team supervisor in case conferences, staff meetings, utilization review and discharge planning meetings to determine if client/member requires an alternate level of care or is appropriate for discharge Participates in 24/7 on-call coverage schedule and performs on-call duties, as required Acts as liaison with other community agencies Provides short term counseling (coping skills, trauma informed, decision making) and Risk Health Assessment/Safety Planning Collects and reports data, as required while adhering to productivity standards Leads and participates in “Network Meetings” with client, client/ member's personal support network and other team members using the Open Dialogue Model Qualifications Master's Degree in Social Work, Psychology, Mental Health Counseling, Family Therapy or related degree Minimum of two years of mental health work experience providing direct services to clients/members with Serious Mental Illness (SMI), developmental disabilities, substance use disorders and/or chronic medical conditions required Effective oral/written/interpersonal communication skills required Bilingual skills may be required as determined by operational needs License and current registration to practice as a Mental Health Counselor, Marriage and Family Therapist , Social Worker, Clinical Social Worker or related license in New York State Valid NYS ID or NYS driver's license may be required as determined by operational needs. Pay Range USD $63,800.00 - USD $79,800.00 /Yr. About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Full-time Description Case Manager I, II, III, IV ** SIGN ON BONUS ELIGIBLE ** Conifer Park is seeking a full-time Case Manager to join our clinical team in Glenville, NY. In this role, the employee assumes full charge of patient case management, delivering individual and group mental health and chemical dependency services including assessment, discharge planning, managed care, and relevant communication, formulation and implementation of treatment plans, and performing specified duties. Schedules: Sundays - Thursdays 8:00am - 4:30pm Tuesdays - Saturdays 8:00am - 4:30pm Mondays - Fridays 8:00am - 4:30pm Tuesdays - Saturdays 10:00am - 6:30pm Requirements Case Manager I Requirements: High School Diploma or GED with a minimum of 1 year of Case Management experience or applicable internship and a CASAC-T certification. Chemical dependency and/or mental health experience preferred and group counseling, didactic skills. Case Manager II Requirements: High School Diploma or GED with 1 year of Case Management experience or applicable internship and posses a current CASAC Certification. Case Manager III Requirements: Bachelor's Degree and current CASAC certification OR Master's licensable degree and a minimum of 1 year relevant experience or applicable internship Case Manager VI Requirements: Master's Licensed Degree with LMHC, LMSW or LCSW Experience in Chemical dependency and/or mental health. Experience in Group counseling and Didactic Skills We offer competitive wages, benefits, and a pension plan in a supportive working environment. Background checks, pre-employment & drug screenings required. Sign on bonus eligible position, payable in three installments for a total of $4000. We are an equal opportunity employer according to standards Schedules: Tuesdays-Saturdays 11:00am-8:00pm INDMP Salary Description $19.86 -$37.62

Full-time Description Case Managers I, II, III, IV PER DIEM OPPORTUNITIES Conifer Park is seeking Per Diem Case Managers to join our clinical team in Glenville, NY. In this role, the employee assumes full charge of patient case management, delivering individual and group mental health and chemical dependency services including assessment, discharge planning, managed care, and relevant communication, formulation and implementation of treatment plans, and performing specified duties. Requirements Case Manager I Requirements: High School Diploma or GED with a minimum of 1 year of Case Management experience or applicable internship and a CASAC-T certification. Chemical dependency and/or mental health experience preferred and group counseling, didactic skills. Case Manager II Requirements: High School Diploma or GED with 1 year of Case Management experience or applicable internship and posses a current CASAC Certification. Case Manager III Requirements: Bachelor's Degree and current CASAC certification OR Master's licensable degree and a minimum of 1 year relevant experience or applicable internship Case Manager VI Requirements: Master's Licensed Degree with LMHC, LMSW or LCSW Experience in Chemical dependency and/or mental health. Experience in Group counseling and Didactic Skills We offer competitive wages, benefits, and a pension plan in a supportive working environment. Background checks, pre-employment & drug screenings required. We are an equal opportunity employer according to standards INDHP Salary Description $19.86 -$37.62

Job Description MISSION STATEMENT Are you ready to give back to the community while pursuing your passion? For over 50 years, Acacia Network and its affiliates have been committed to improving the quality-of-life and wellbeing of underserved communities in New York City and beyond. We are one of the leading human services organizations in New York City and the largest Hispanic-led nonprofit in the State, serving over 150,000 individuals every year. Our programs serve individuals at every age and developmental level, from the very young through our daycare programs to mature adults through our older adults centers. Our extensive array of community-based services are fully integrated, bilingual and culturally competent. POSITION OVERVIEW Under supervision of the Program Director, the Case Manager is responsible for providing case management, housing support to participants and monthly reporting requirements that will ensure compliance with the parameters of the program. The requirements listed below represent the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities as defined by the ADA to perform the essential functions of the job. KEY ESSENTIAL FUNCTIONS Provide targeted case management services to children, youth and adult consumers living with mental health illnesses and substance abuse disorders and their families/support systems through ensuring access to care, engagement in care coordination of care to obtain the full range of needed services. Gather enrollment consents, PSYCKES/RHIO consents, and complete screening, baseline-risk assessments, reassessments, plan of care, plan of care updates and notes in accordance with departmental policies. Demonstrate the ability to clearly articulate, verbally and in writing, the aims and goals of the department to potential patients, community members and staff. Participate in quality improvement activities, projects and reviews in collaboration clinical team members. Complete daily, weekly, monthly, or other periodic requests for narrative or quantitative data reports for program review. Prioritize the homeless population through identification of new sources of potential patients, onsite meetings with patients at their shelter and conduct outreach and engagement presentations. Meet regularly with supervisor and attend staff meetings and case conferences. Be prepared to discuss case management and operational issues impacting performance and program operations. Complete and submit daily activity log in accordance with departmental policies. Ensure patient is attending scheduled medical and social service visits through building relationships with patients and providers. Coordinate and schedule appointments with Social Worker and Medical/Mental Health providers. Routine calls should be made to internal and external providers before and after visits to follow up and provide necessary support to the patients. Maintain four contacts with each client or at a greater frequency as indicated by the risk stratification and plan of care. Access and respond per agency guidelines to client complaints of grievances Conduct outreach and engagement in accordance with policies via phone, electronic methods, and letter and or field work to client/collateral/provider to engage clients or strengthen connectivity. Help maintain health and wellness and prevent secondary disease complications through provision of health information, support plan of care, and coaching. Promote and expand linkage development in all areas related to patient care including social determinants (e.g. housing, employment) and monitor the effectiveness of linkages with other service providers via phone, face to face meetings of formal case conferences. Communicate effectively with Supervisor in identifying strengths, weakness and opportunities of program operations. Ensure community-follow up to engage the client in care; promote compliance with medical appointments and encourages client self-sufficiency and empowerment. Identify and attend training for professional development and attend departmental in-service meetings as required. REQUIREMENTS High School Diploma or GED required. Associate Degree and Bachelor's degree preferred. Minimum of six (6) years of experience in case management. Must obtain Mandated reporter (2 hours) training/certificate required. Website info: **************************************************** Must complete Integrated Mental Health/Addictions Treatment Training (IMHATT) Certificate within three (3) months of hire date. Must complete Integrated Mental Health/Addictions Treatment Training (IMHATT) Certificate Must be trained in Trauma Informed Care and in Military and Veteran's culture Must be team oriented and possess a positive attitude with a willingness to be flexible and helpful. Must be able to multi-task with strong organizational skills. Excellent interpersonal skills and able to communicate both verbally and in written form. Commitment to cultural diversity and sensitivity. Ability to maintain a professional demeanor under pressure and operate with keen sense of urgency and commitment to quality. WHY JOIN US? Acacia Network provides a comprehensive and competitive benefits package to our employees. In addition to a competitive salary, our benefits include medical, dental, and vision coverage. We also offer generous paid time off, including vacation days and paid holidays, to support a healthy work-life balance. We prioritize the well-being of our employees both professionally and personally. As an Equal Opportunity Employer, we encourage individuals from all backgrounds to apply.

Job Description MISSION STATEMENT Are you ready to give back to the community while pursuing your passion? For over 50 years, Acacia Network and its affiliates have been committed to improving the quality-of-life and wellbeing of underserved communities in New York City and beyond. We are one of the leading human services organizations in New York City and the largest Hispanic-led nonprofit in the State, serving over 150,000 individuals every year. Our programs serve individuals at every age and developmental level, from the very young through our daycare programs to mature adults through our older adults centers. Our extensive array of community-based services are fully integrated, bilingual and culturally competent. POSITION OVERVIEW The Case Manager provides supports the wellness and recovery goals of individuals with complex and/or chronic behavioral health and substance abuse issues and needs by implementing targeted interventions designed to provide timely, high-quality, and efficient care. Targeted Case Management services are tailored around goals aimed at providing services that encourage individuals to resolve problems that interfere with their attainment or maintenance of independence or self-sufficiency. The Case manager must have knowledge of community resources and counseling/social work practices with high-risk populations. The Case Manager must have experience working with persons in crisis while attaining the ability to work independently with a strong sense of focus. Must be task-oriented, nonjudgmental and maintain boundary with individuals. The case manager must be able to work in a variety of settings with culturally diverse families while having the ability to be culturally sensitive and appropriate. Maintain a caseload and meet with patients on a weekly basis. The goal of the case manager is to help patients regain optimum health or improve functional capability, in the right setting. It involves assessments, comprehensive diagnostic and treatment planning evaluation to achieve wellness and recovery goals. Case managers are the cohort in accessing services via referral, linkage to needed services, and monitoring follow up on patient care in order to meet the individual's needs. KEY ESSENTIAL FUNCTIONS Provide targeted case management services to children, youth and adult consumers living with mental health illnesses and substance abuse disorders and their families/support systems through ensuring access to care, engagement in care coordination of care to obtain the full range of needed services. Gather enrollment consents, PSYCKES/RHIO consents, and complete screening, baseline-risk assessments, reassessments, plan of care, plan of care updates and notes in accordance with departmental policies. Demonstrate the ability to clearly articulate, verbally and in writing, the aims and goals of the department to potential patients, community members and staff. Participate in quality improvement activities, projects and reviews in collaboration clinical team members. Complete daily, weekly, monthly, or other periodic requests for narrative or quantitative data reports for program review. Prioritize the homeless population through identification of new sources of potential patients, onsite meetings with patients at their shelter and conduct outreach and engagement presentations. Meet regularly with supervisor and attend staff meetings and case conferences. Be prepared to discuss case management and operational issues impacting performance and program operations. Complete and submit daily activity log in accordance with departmental policies. Ensure patient is attending scheduled medical and social service visits through building relationships with patients and providers. Coordinate and schedule appointments with Social Worker and Medical/Mental Health providers. Routine calls should be made to internal and external providers before and after visits to follow up and provide necessary support to the patients. Maintain four contacts with each client or at a greater frequency as indicated by the risk stratification and plan of care. Access and respond per agency guidelines to client complaints of grievances Conduct outreach and engagement in accordance with policies via phone, electronic methods, and letter and or field work to client/collateral/provider to engage clients or strengthen connectivity. Help maintain health and wellness and prevent secondary disease complications through provision of health information, support plan of care, and coaching. Promote and expand linkage development in all areas related to patient care including social determinants (e.g. housing, employment) and monitor the effectiveness of linkages with other service providers via phone, face to face meetings of formal case conferences. Communicate effectively with Supervisor in identifying strengths, weakness and opportunities of program operations. Ensure community-follow up to engage the client in care; promote compliance with medical appointments and encourages client self-sufficiency and empowerment. Identify and attend training for professional development and attend departmental in-service meetings as required. REQUIREMENTS High School Diploma or GED required. Associate Degree and Bachelor's degree preferred. Minimum of six (6) years of experience in case management. Must obtain Mandated reporter (2 hours) training/certificate required. Website info: **************************************************** Must complete Integrated Mental Health/Addictions Treatment Training (IMHATT) Certificate within three (3) months of hire date. Must complete Integrated Mental Health/Addictions Treatment Training (IMHATT) Certificate Must be trained in Trauma Informed Care and in Military and Veteran's culture Must be team oriented and possess a positive attitude with a willingness to be flexible and helpful. Must be able to multi-task with strong organizational skills. Excellent interpersonal skills and able to communicate both verbally and in written form. Commitment to cultural diversity and sensitivity. Ability to maintain a professional demeanor under pressure and operate with keen sense of urgency and commitment to quality. WHY JOIN US? Acacia Network provides a comprehensive and competitive benefits package to our employees. In addition to a competitive salary, our benefits include medical, dental, and vision coverage. We also offer generous paid time off, including vacation days and paid holidays, to support a healthy work-life balance. We prioritize the well-being of our employees both professionally and personally. As an Equal Opportunity Employer, we encourage individuals from all backgrounds to apply.

The case manager will be assisting the social worker in providing case management services to victims of crimes. Among other things, this will include assisting clients with navigating court and medical appointments, applying for compensation through OVS, and connecting individuals to educational/vocational services. Requirements (Education, Experience, Certification, Knowledge, Skill) Associates degree from an accredited university Experience working in the social services field 2+ years of experience working in or near the SNUG target areas Position Responsibilities Work as an onsite case manager and member of the SNUG team in order to support victims of crime affected by community violence Manage the site's referral resource database and create relationships with local agencies and service providers Assist victims of crime navigate systems including providing court advocacy and transportation to medical appointments Work with the SNUG staff and assist them in providing case management services to their high-risk program participants. Respond with SNUG team to violent incidents in the community, attend SNUG outreach events, and make home visits to victims and families when appropriate Develop relationships with hospitals and other crime victim service providers in order to ensure crime victims know about and utilize SNUG services Maintain a sufficient caseload of clients at any given time Adhere to all documentation and database requirements and accurately track work in accordance with VOCA reporting standards Willingness to travel to trainings and conferences including an initial week-long training that may require overnight travel within NYS, and a biannual two-day conference in Albany Be available to support SNUG team in emergency situations regarding incidents with staff or participants Ability to work flexible hours (evenings and weekends) when necessary Any other relevant duties as assigned Working Conditions/Environment: Requires frequent exposure to individuals displaying high-risk/violent behaviors. Requires frequent weekend and night hours. Requires frequent travel within the City of Syracuse to different sites as well as some travel for training purposes. Transportation Requirement Position requires an automobile, driver's license, and insurance Last Updated: Created 9/20/2021 Replaces: N/A

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

PRIMARY PURPOSE: The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker's compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years' experience overseeing a nursing claims management program as well as in-depth understanding of worker's compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical treatment and engagement of the injured worker to achieve a safe and reasonable return to work. This position requires interaction with physicians, other medical providers, claims professionals, supervision, injured employees and employers. Responsibilities Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers. Responsible for all oversight of operational and administrative activities within the department/unit. Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded. Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff. Management of performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions. Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations. Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level. Ensures appropriate compliance with all legislation, corporate policies, and programs. Assist Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews. Implements new and revised policies and procedures. Performs additional duties and/or is assigned special projects as requested. Qualifications Education & Licensing Ability to develop, manage and direct an office/unit operation and effectively communicate operational procedures to field/unit staff. Demonstrated leadership and innovation in achieving results. Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies. Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. National Certification in case management OR the ability to obtain certification within 24 months of employment is required. Written and verbal fluency in Spanish and English preferred. Experience Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management. Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience. Skills & Knowledge: Knowledge of workers' compensation laws and regulations Knowledge of case management practice Knowledge of the nature and extent of injuries, periods of disability, and treatment needed Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation Knowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies The expected salary range for this role is $92,000-$120,00.00. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-GH1 #LI-HYBRID #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Full-time Description SCHEDULE: Full-Time: Monday-Friday 8am-4:30pm, on call required. The Peer Care Manager provides CTI services from a lived- experience and non-clinical perspective, have experienced directly one or more of the following: mental illness, substance use, homelessness or trauma. The Peer Care Manager will develop person-centered care plans, share knowledge of community resources, provide linkage to resources, engage individuals in skill building, offer crisis management, collaborate with other providers, assist individuals in navigating complex systems, and work with informal supports. ESSENTIAL DUTIES AND RESPONSIBILITIES Complete all CTI, agency and state required trainings, as assigned. Foster a beneficial working relationship with the partnering hospital by attending regular meetings with hospital staff and communicating effectively. Provide care coordination services for a maximum of 15 individuals. Link individuals to supports in the community to promote community tenure and management of their behavioral and physical health needs. Maintain documentation in the electronic health record according to the requirements of the CTI manual and agency policies and procedures. Provide CTI core services to individuals to include: person-centered planning, psychosocial rehabilitative services, crisis prevention services, health services and care coordination services. Participate in weekly case presentations to review caseload and provide updates to include an individual's CTI phase, upcoming transitions in care, completed activities and planned activities for the week. Provide reporting data to the Team Lead, including the Implementation Self-Assessment Form. Adhere to the guiding principles of the trauma-informed approach (via SAMHSA's National Center for Trauma-Informed Care). Attend case conferences to troubleshoot and problem solve treatment challenges and coordinate care between providers and/or collaterals. Assist the Team Lead in maintaining an up-to-date community resources list and necessary information on how to access these resources. Participate in CTI Learning Collaborative. Participate in the CTI Learning Community. This community is a collaboration with the Office of Mental Health (OMH) to review progress, outcomes and develop best practices for the CTI Team. Function as a member of a multi-disciplinary team. Must be part of the after-hours on-call rotation. Maintain client confidentiality at all times. Performs other duties as assigned or that may develop. Management has the right to add or change the duties of this position at any time. Requirements 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 and/or EXPERIENCE Required: Must be at least 18 years of age, have attained a high-school diploma or equivalent, and at least six (6) months of direct care experience with individuals with serious mental illness. Certified Peer Specialist through nypscb.or or willingness to obtain certification within six (6) months of hire. CERTIFICATES, LICENSES, REGISTRATIONS Must maintain valid driver's license and acceptable driving record. Salary Description $23.08/hr

Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after hire. At least 3 years of recent clinical and Case Management experience. Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home required. Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations. 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: Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, coordination of care and resource allocation. The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. The position will provide guidance in understanding benefit coverage and navigating the health care delivery system. The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Service Authorization & Review: Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of LTSS services. Care Coordination: Collaborate with case managers, care coordinators, and providers to ensure integrated, person-centered care. Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (e.g., NCQA), including documentation and reporting. Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution. Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines. 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: This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown).

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a **Case Manager, Medicaid Long Term Support Program** to join #TeamMVP. If you have a passion for advocacy, collaboration and problem solving and innovation this is the opportunity for you. **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 and one of the **Best Companies to Work For in New York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home required. + Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations. + 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:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, coordination of care and resource allocation. + The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. + The position will provide guidance in understanding benefit coverage and navigating the health care delivery system. + The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of LTSS services. + Care Coordination: Collaborate with case managers, care coordinators, and providers to ensure integrated, person-centered care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (e.g., NCQA), including documentation and reporting. + Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution. + Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines. + 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:** This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown). **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. **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 ******************** . **Job Details** **Job Family** **Medical Management/Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD** **Hiring Max Rate** **102,350 USD**

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $104,000.00 - $171,700.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign on bonus up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff. **What Will You Do?** + Directly handle assigned severe claims. + Full damage value for average claim (without regard to coverage or liability defenses): $500,000 to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value. + Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. + Work with Manager on use of Claim Coverage Counsel as needed. + Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. + Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. + Complete outside investigation as needed per case specifics. + Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts. + Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. + Maintain claim files and document claim file activities in accordance with established procedures. + Develop and employ creative resolution strategies. + Responsible for prompt and proper disposition of all claims within delegated authority. + Negotiate disposition of claims with insureds and claimants or their legal representatives. + Recognize and implement alternate means of resolution. + Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. + Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. + Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure. + Establish and maintain proper indemnity and expense reserves. + Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims. + Recommend appropriate cases for discussion at roundtable. + Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. + Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others. + Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance. + Apply litigation management through the selection of counsel, evaluation. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred. + 10+ years claim handling experience with 5-7 years experience handling serious injury and complex liability claims preferred. + Extensive working level knowledge and skill in various business line products. + Excellent negotiation and customer service skills. + Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills. + Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. + Able to make independent decisions on most assigned cases without involvement of supervisor. + Openness to the ideas and expertise of others and actively solicits input and shares ideas. + Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices. + Demonstrated strong coaching, influence and persuasion skills. + Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. + Can adapt to and support cultural change. + Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. + Analytical Thinking - Advanced + Judgment/Decision Making - Advanced + Communication - Advanced + Negotiation - Advanced + Insurance Contract Knowledge - Advanced + Principles of Investigation - Advanced + Value Determination - Advanced + Settlement Techniques - Advanced + Litigation Management - Advanced + Medical Terminology and Procedural Knowledge - Advanced **What is a Must Have?** + 10+ years claim handling experience or related experience with 3-5 years experience handling serious injury and complex liability claims. High School Degree or GED required; In order to perform the essential job functions of this job, acquisition and maintenance of Property/Causalty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $104,000.00 - $171,700.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign on bonus up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff. What Will You Do? * Directly handle assigned severe claims. * Full damage value for average claim (without regard to coverage or liability defenses): $500,000 to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value. * Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Work with Manager on use of Claim Coverage Counsel as needed. * Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. * Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Complete outside investigation as needed per case specifics. * Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts. * Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Maintain claim files and document claim file activities in accordance with established procedures. * Develop and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiate disposition of claims with insureds and claimants or their legal representatives. * Recognize and implement alternate means of resolution. * Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Utilize evaluation documentation tools in accordance with department guidelines. * Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. * Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure. * Establish and maintain proper indemnity and expense reserves. * Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims. * Recommend appropriate cases for discussion at roundtable. * Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others. * Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance. * Apply litigation management through the selection of counsel, evaluation. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred. * 10+ years claim handling experience with 5-7 years experience handling serious injury and complex liability claims preferred. * Extensive working level knowledge and skill in various business line products. * Excellent negotiation and customer service skills. * Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills. * Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others and actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices. * Demonstrated strong coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced * Judgment/Decision Making - Advanced * Communication - Advanced * Negotiation - Advanced * Insurance Contract Knowledge - Advanced * Principles of Investigation - Advanced * Value Determination - Advanced * Settlement Techniques - Advanced * Litigation Management - Advanced * Medical Terminology and Procedural Knowledge - Advanced What is a Must Have? * 10+ years claim handling experience or related experience with 3-5 years experience handling serious injury and complex liability claims. High School Degree or GED required; In order to perform the essential job functions of this job, acquisition and maintenance of Property/Causalty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $104,000.00 - $171,700.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign on bonus up to $20,000. Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Major Case Specialist, you are responsible for investigating, evaluating, reserving, negotiating, and resolving complex, serious and severe claims typically with full damage value for average claim $500,000 to over a multi-million dollar value. You will serve as an expert technical resource to claim professionals, business partners, customers, and other stakeholders. **What Will You Do?** + Oversee major General Liability claims from initiation to resolution, ensuring compliance with company policies and industry regulations. + Conduct detailed investigations to gather evidence, assess liability and determine extent of damages. + Evaluate claim information and documentation to make informed decisions regarding coverage and settlement. + Engage in negotiations with claimants, legal representatives, and other parties to achieve fair and equitable settlements. + Maintain comprehensive and accurate records of all claim activities, communications, and decisions. + Prepare and present detailed reports on claim status, trends and outcomes to senior management. + Work closely with legal, underwriting, and other departments to ensure coordinated claim handling. + Apply litigation management strategies through the selection of counsel and evaluation. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. **What Will Our Ideal Candidate Have?** + Bachelor's Degree. + Ten years of experience in handling major General Liability claims and managing litigation and complex negotiations. + Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. + Able to make independent decisions on most assigned cases without involvement of management. + Thorough understanding of business line products, policy language, exclusions, and ISO forms. + Demonstrated ability of strategic claims handling practices. + Strong written and verbal communication skills with the ability to understand, synthesize, interpret, and convey information in a simplified manner. + Familiarity with industry regulations and legal requirements specific to XX insurance. + Ability to work independently and manage multiple high-value claims simultaneously. **What is a Must Have?** + High School Degree or GED required with a minimum of 4 years bodily injury litigation claim handling or comparable claim litigation experience. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $104,000.00 - $171,700.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign on bonus up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff. **What Will You Do?** + Directly handle assigned severe claims. + Full damage value for average claim (without regard to coverage or liability defenses): $500,000 to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value. + Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. + Work with Manager on use of Claim Coverage Counsel as needed. + Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. + Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. + Complete outside investigation as needed per case specifics. + Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts. + Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. + Maintain claim files and document claim file activities in accordance with established procedures. + Develop and employ creative resolution strategies. + Responsible for prompt and proper disposition of all claims within delegated authority. + Negotiate disposition of claims with insureds and claimants or their legal representatives. + Recognize and implement alternate means of resolution. + Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. + Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. + Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure. + Establish and maintain proper indemnity and expense reserves. + Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims. + Recommend appropriate cases for discussion at roundtable. + Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. + Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others. + Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance. + Apply litigation management through the selection of counsel, evaluation. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred. + 10+ years claim handling experience with 5-7 years experience handling serious injury and complex liability claims preferred. + Extensive working level knowledge and skill in various business line products. + Excellent negotiation and customer service skills. + Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills. + Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. + Able to make independent decisions on most assigned cases without involvement of supervisor. + Openness to the ideas and expertise of others and actively solicits input and shares ideas. + Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices. + Demonstrated strong coaching, influence and persuasion skills. + Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. + Can adapt to and support cultural change. + Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. + Analytical Thinking - Advanced + Judgment/Decision Making - Advanced + Communication - Advanced + Negotiation - Advanced + Insurance Contract Knowledge - Advanced + Principles of Investigation - Advanced + Value Determination - Advanced + Settlement Techniques - Advanced + Litigation Management - Advanced + Medical Terminology and Procedural Knowledge - Advanced **What is a Must Have?** + 10+ years claim handling experience or related experience with 3-5 years experience handling serious injury and complex liability claims. High School Degree or GED required; In order to perform the essential job functions of this job, acquisition and maintenance of Property/Causalty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $104,000.00 - $171,700.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign on bonus up to $20,000. Be the Hero in Someone's Story When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most. As a Major Case Specialist, you are responsible for investigating, evaluating, reserving, negotiating, and resolving complex, serious and severe claims typically with full damage value for average claim $500,000 to over a multi-million dollar value. You will serve as an expert technical resource to claim professionals, business partners, customers, and other stakeholders. What Will You Do? * Oversee major General Liability claims from initiation to resolution, ensuring compliance with company policies and industry regulations. * Conduct detailed investigations to gather evidence, assess liability and determine extent of damages. * Evaluate claim information and documentation to make informed decisions regarding coverage and settlement. * Engage in negotiations with claimants, legal representatives, and other parties to achieve fair and equitable settlements. * Maintain comprehensive and accurate records of all claim activities, communications, and decisions. * Prepare and present detailed reports on claim status, trends and outcomes to senior management. * Work closely with legal, underwriting, and other departments to ensure coordinated claim handling. * Apply litigation management strategies through the selection of counsel and evaluation. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. What Will Our Ideal Candidate Have? * Bachelor's Degree. * Ten years of experience in handling major General Liability claims and managing litigation and complex negotiations. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of management. * Thorough understanding of business line products, policy language, exclusions, and ISO forms. * Demonstrated ability of strategic claims handling practices. * Strong written and verbal communication skills with the ability to understand, synthesize, interpret, and convey information in a simplified manner. * Familiarity with industry regulations and legal requirements specific to XX insurance. * Ability to work independently and manage multiple high-value claims simultaneously. What is a Must Have? * High School Degree or GED required with a minimum of 4 years bodily injury litigation claim handling or comparable claim litigation experience. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $104,000.00 - $171,700.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign on bonus up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training and serves as an expert technical resource to other claim professionals, business partners, customers, and other stakeholders as appropriate or required. This position does not manage staff. What Will You Do? * Directly handle assigned severe claims. * Full damage value for average claim (without regard to coverage or liability defenses): $500,000 to several million dollars, amounting to a typical inventory of claims with FDV of over a multi-million dollar value. * Provide quality customer service and ensure file quality, timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Work with Manager on use of Claim Coverage Counsel as needed. * Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. * Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Complete outside investigation as needed per case specifics. * Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants nurse consultants, and fire or fraud investigators, and other experts. * Verify the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Maintain claim files and document claim file activities in accordance with established procedures. * Develop and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiate disposition of claims with insureds and claimants or their legal representatives. * Recognize and implement alternate means of resolution. * Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Utilize evaluation documentation tools in accordance with department guidelines. * Proactively review Claim File Analysis (CFA) for adherence to quality standards and trend analysis. * Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure. * Establish and maintain proper indemnity and expense reserves. * Provide guidance to underwriting business partners with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims. * Recommend appropriate cases for discussion at roundtable. * Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others. * Apply the Company's claim quality management protocols, and metrics to all claims; document the rationale for any departure from applicable protocols and metrics with or without assistance. * Apply litigation management through the selection of counsel, evaluation. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred. * 10+ years claim handling experience with 5-7 years experience handling serious injury and complex liability claims preferred. * Extensive working level knowledge and skill in various business line products. * Excellent negotiation and customer service skills. * Advanced skills in coverage, liability and damages analysis with expert understanding of the litigation process in both state and federal courts, including relevant case and statutory law and procedure; expert litigation management skills. * Extensive claim and/or legal experience and thus the technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others and actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms and effective claims handling practices. * Demonstrated strong coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced * Judgment/Decision Making - Advanced * Communication - Advanced * Negotiation - Advanced * Insurance Contract Knowledge - Advanced * Principles of Investigation - Advanced * Value Determination - Advanced * Settlement Techniques - Advanced * Litigation Management - Advanced * Medical Terminology and Procedural Knowledge - Advanced What is a Must Have? * 10+ years claim handling experience or related experience with 3-5 years experience handling serious injury and complex liability claims. High School Degree or GED required; In order to perform the essential job functions of this job, acquisition and maintenance of Property/Causalty Adjuster License(s) may be required to comply with state and Travelers requirements. Generally, license(s) are required to be obtained within three months of starting the job. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

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