Professional, Behavioral Health
Foster care worker job 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 **Professional, Behavioral Health** to join #TeamMVP. If you have a passion for healthcare, improving access to care, enhancing quality and compliance 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 in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** .
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
**Qualifications you'll bring:**
+ Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
+ New York State license required
+ Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
+ Willingness and ability to obtain equivalent license in Vermont
+ Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
+ Utilization or Case Management experience in a managed care organization is preferred
+ Knowledgeable with diagnosis and procedural coding preferred
+ Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
+ Ability to make independent decisions regarding resource utilization, and quality of care.
+ Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
+ 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:**
+ Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
+ Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
+ Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
+ Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
+ Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
+ Maintain accurate and timely documentation in compliance with regulatory standards.
+ Participate in quality improvement initiatives and team meetings.
+ Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
+ Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
**Where you'll be:**
Virtual in NYS
**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** **98,000 USD**
Professional, Behavioral Health
Foster care worker job at MVP Health Care
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
Qualifications you'll bring:
Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
New York State license required
Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
Willingness and ability to obtain equivalent license in Vermont
Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
Utilization or Case Management experience in a managed care organization is preferred
Knowledgeable with diagnosis and procedural coding preferred
Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
Ability to make independent decisions regarding resource utilization, and quality of care.
Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
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:
Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
Maintain accurate and timely documentation in compliance with regulatory standards.
Participate in quality improvement initiatives and team meetings.
Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual in NYS
Licensed Behavioral Health Counselor
Islandia, NY jobs
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.
Social Services - Case Worker
New York, NY jobs
Estimated Gross Weekly Pay: $0.00
About Alliance Services:
Alliance services, Inc. wants you on our team! As a nurse-founded, nurse-owned, minority-owned travel-nurse agency, it is our first priroity to ensure that we offer top pay and an outstanding employee experience from start to finish. Making sure that you receive the most generous pay package possible, and a career-enhancing clinical experience at the destination of your choice. Our dedicated recruiters are committed to providing excellent service to you and foster a greater sense of belonging as not just an employee, but as a valued member of our extended family.
Industry Leading Benefits:
Weekly pay via direct deposit and accessible payroll support
401k with 100% matching
Monthly reimbursement for health insurance
Maximum non-tax stipends available including lodging, meals and incidentals
24/7 On-call support
Case Manager
Glenville, NY jobs
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
Health Fitness Professional (part-time)
Harrison, NY jobs
HealthFitness is looking for a part-time, 20 hours per week, Health Fitness Professional to join the team at our client site located in Purchase, NY. In this role, you will make a direct impact on the health and well-being of our members through the coordination, implementation, and delivery of health and fitness improvement programs and services, fitness center promotions and outreach activities. You will provide individual and group exercise instruction, monitor fitness facility and conduct fitness testing and assessments, advising participants of the results and designing individualized programs to meet the members' interests, abilities and goals.
Schedule: 20 hours per week, Monday-Friday, hours will vary between 5:30am-7:30pm, must do two closing shifts per week
Care Manager Social Worker
New York, NY jobs
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
Case Manager SNUG
Syracuse, NY jobs
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
Auto-ApplyMajor Case Specialist, Construction
New York, NY jobs
**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 ******************************************************** .
Major Case Specialist, Construction
New York, NY jobs
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 *********************************************************
Major Case Specialist, GL
Melville, NY jobs
**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 ******************************************************** .
Major Case Specialist, Construction
Melville, NY jobs
**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 ******************************************************** .
Major Case Specialist, Construction
Melville, NY jobs
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 *********************************************************
Major Case Specialist, GL
Melville, NY jobs
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 *********************************************************
Commercial Claims Counsel
New York, NY jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
GEICO is seeking Commercial Claims Counsel to join its Corporate Litigation and Investigations Division. The Commercial Claims Counsel should have experience advising claims organizations in insurance coverage and claims-related litigation arising from commercial insurance policies. The Commercial Claims Counsel will identify, develop, and maintain the Company's position on commercial claims related litigation, bad faith claims, and extra-contractual matters.
The Commercial Claims Counsel will be expected to provide legal services and advice regarding commercial insurance claims of heightened complexity, complex extracontractual matters, bad faith, and other major litigation and manage large-scale projects. The position may involve other duties, as assigned.
This role will partner closely with other business teams, while forming part of a collaborative legal department that is valued for its practical advice. The ideal candidate will have at least 5-7 years of relevant substantive experience in a law firm or in-house legal department, including experience managing or litigating bad faith or extra-contractual allegations. In addition, the successful candidate will have excellent communication and interpersonal skills, strong judgment, strong research and writing skills, and an eagerness to be involved in a dynamic company.
Primary Responsibilities:
Provide legal advice to the claims organization on claims of heightened complexity, bad faith, coverage, and extra-contractual allegations against the Companies.
* Perform factual and legal research and analysis
* Review documents at the request of Legal Department management
* Develop and conduct in-house presentations on research projects.
Basic Qualifications:
* Juris Doctor (JD) degree from an accredited law school
* Admission to practice law in at least one U.S. jurisdiction.
* 5-7 years of litigation management experience at a law firm, government, and/or in-house role.
* Strong analytical, problem-solving, and decision-making skills.
* Up-to-date understanding of the key legal issues germane to an organization
* Excellent written and verbal communication skills, with the ability to explain complex legal concepts to non-lawyers.
* Proficiency in managing multiple priorities, projects, and stakeholders.
* Trial and/or appellate experience.
* Experience handling bad faith or extra-contractual litigation against an insurance company.
Preferred Qualifications:
* A background in commercial insurance coverage and litigation.
* Experience working as a Claims Counsel or Claims Attorney at an insurance company, preferably with an expertise in Commercial Claims.
* Experience working with cross-functional teams, both legal and non-legal.
* Federal or State court Clerkship.
Hybrid In-Office Work Schedule - 3 days per week in office required. This position can be based out of Bethesda, MD, Cleveland, OH or New York, NY
Annual Salary
$135,300.00 - $235,750.00
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
* Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
* Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
* Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
* Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Auto-ApplyProfessional, Behavioral Health
Foster care worker job at MVP Health Care
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
Qualifications you'll bring:
Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
New York State license required
Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
Willingness and ability to obtain equivalent license in Vermont
Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
Utilization or Case Management experience in a managed care organization is preferred
Knowledgeable with diagnosis and procedural coding preferred
Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
Ability to make independent decisions regarding resource utilization, and quality of care.
Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
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:
Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
Maintain accurate and timely documentation in compliance with regulatory standards.
Participate in quality improvement initiatives and team meetings.
Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual in NYS
Professional, Behavioral Health
Foster care worker job 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 **Professional, Behavioral Health** to join #TeamMVP. If you have a passion for healthcare, improving access to care, enhancing quality and compliance 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 in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** .
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
**Qualifications you'll bring:**
+ Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
+ New York State license required
+ Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
+ Willingness and ability to obtain equivalent license in Vermont
+ Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
+ Utilization or Case Management experience in a managed care organization is preferred
+ Knowledgeable with diagnosis and procedural coding preferred
+ Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
+ Ability to make independent decisions regarding resource utilization, and quality of care.
+ Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
+ 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:**
+ Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
+ Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
+ Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
+ Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
+ Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
+ Maintain accurate and timely documentation in compliance with regulatory standards.
+ Participate in quality improvement initiatives and team meetings.
+ Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
+ Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
**Where you'll be:**
Virtual in NYS
**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** **98,000 USD**
Professional, Behavioral Health
Foster care worker job at MVP Health Care
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
Qualifications you'll bring:
Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
New York State license required
Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
Willingness and ability to obtain equivalent license in Vermont
Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
Utilization or Case Management experience in a managed care organization is preferred
Knowledgeable with diagnosis and procedural coding preferred
Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
Ability to make independent decisions regarding resource utilization, and quality of care.
Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
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:
Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
Maintain accurate and timely documentation in compliance with regulatory standards.
Participate in quality improvement initiatives and team meetings.
Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual in NYS
Professional, Behavioral Health
Foster care worker job 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 **Professional, Behavioral Health** to join #TeamMVP. If you have a passion for healthcare, improving access to care, enhancing quality and compliance 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 in the NY Capital District** , one of **the Best Companies to Work For in New York** , and an **Inclusive Workplace** .
The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This individual will make triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA). This role will also provide care coordination to support members in meeting their behavioral health needs.
**Qualifications you'll bring:**
+ Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required
+ New York State license required
+ Licensed Behavior Analyst (LBA) or Board-Certified Behavior Analyst (BCBA) preferred. If possessing an LBA, another clinical license is not required.
+ Willingness and ability to obtain equivalent license in Vermont
+ Minimum of 3 years of direct clinical practice (mental health and/or substance use) with children and/or adolescents, with at least 2 years being ASD related
+ Utilization or Case Management experience in a managed care organization is preferred
+ Knowledgeable with diagnosis and procedural coding preferred
+ Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
+ Ability to make independent decisions regarding resource utilization, and quality of care.
+ Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.
+ 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:**
+ Review all requests for behavioral health services utilizing the appropriate behavioral health and MVP standards and criteria tools, including MVP Health Care Medical Policy, Change Health Care's InterQual Criteria, the New York State Office of Addictions Services and Supports Level of Care (OASAS) for Alcohol and Drug Treatment Referral (LOCADTR) tool, and other guidelines provided by the states of New York and Vermont.
+ Conduct prospective, concurrent, and retrospective reviews in adherence with MVP, state, federal, and accreditation guidelines and rules.
+ Provide care management and coordination for MVP customers to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual's behavioral health needs.
+ Collaborate with internal and external stakeholders to support coordination of services across behavioral health, medical, and social domains.
+ Consult with Leadership, Behavioral Health Medical Directors, and an integrated team of physicians and clinicians, on challenging and high-risk cases.
+ Maintain accurate and timely documentation in compliance with regulatory standards.
+ Participate in quality improvement initiatives and team meetings.
+ Responsible for making triage and referral decisions requiring clinical judgement, with an emphasis placed on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA).
+ Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
**Where you'll be:**
Virtual in NYS
**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** **98,000 USD**
Family Support Specialist Program Manager
Johnson City, NY jobs
Responsive recruiter Benefits:
401(k) matching
Competitive salary
Dental insurance
Health insurance
Paid time off
Training & development
Vision insurance
Wellness resources
JOB TITLE: FAMILY SUPPORT SPECIALIST PROGRAM MANAGER REPORTS TO: DEPUTY DIRECTOR
Position Summary: The Family Support Services Program Manager oversees the implementation, coordination, and quality of the agency's PAL Family Resource Centers and other related programs. This leadership role ensures all activities align with the organization's mission to strengthen families, promote healthy development in young children, and support parents and caregivers through welcoming, inclusive services. The Program Manager supervises the team of PAL Coordinators, guides program planning and evaluation, and ensures contract compliance.
Key Responsibilities:
Leadership & Administration
Provide strategic oversight and daily management of all programs and Family Resource Centers.
Supervise and support PAL staff, interns, and volunteers.
Plan and coordinate Center activities and ensure program alignment with state and local grant deliverables.
Assist in the develop of annual program workplans, grant applications, and new proposals in collaboration with the Deputy Director.
Prepare and submit timely monthly, quarterly, and annual programmatic reports, evaluations, and supporting documentation to funders and internal leadership.
Support hiring, onboarding, training, and ongoing professional development of program staff.
Foster a collaborative team culture with an emphasis on family support principles and trauma-informed practices.
Program Development & Delivery
Approve and guide the development of activities and curricula that promote age-appropriate child development and caregiver education.
Ensure all center environments are welcoming, safe, culturally sensitive, and accessible.
Facilitate or oversee educational and support programming, including parenting workshops, family engagement events, and community-based collaborations.
Provide regular on-site support to each Family Resource Center and maintain a visible, engaged presence with families and staff.
Monitor the quality of parent/child interactions and role-model nurturing, respectful engagement.
Data Management & Evaluation
Ensure accurate collection and input of data, including intake forms, progress notes, contact logs, and attendance, into the AWARDS or other data systems.
Review and analyze data to evaluate program effectiveness and identify areas for improvement.
Coordinate outcome tracking for all centers and support continuous quality improvement.
Community Engagement & Partnerships
Serve as a liaison with community partners, subcontractors, and local agencies to strengthen referral networks and secure in-kind services.
Represent Family Support Services at meetings, coalitions, and public events.
Promote the agency and programs through outreach, education, and collaboration with external stakeholders.
Required Qualifications:
Bachelor's degree in social work, Early Childhood, Human Services, Public Health, or a related field.
At least 1-2 years of experience in a supervisory or program leadership role.
Proficiency in program development, staff supervision, and data reporting.
Knowledge of early childhood development, parenting education, ACEs, trauma-informed care, and family support best practices.
Strong oral and written communication, organizational, and interpersonal skills.
Familiarity with the needs of high-risk populations and the local human services landscape.
Willingness to work some evenings or weekends for special events or outreach.
Core Competencies:
Commitment to equity, inclusion, and family-centered care.
Ability to manage multiple programs and priorities with flexibility and initiative.
Leadership that fosters collaboration, trust, and accountability.
Comfort with databases, data analysis, and outcome reporting.
Strong emotional intelligence and resilience in working with vulnerable populations.
THE POSITION OF PAL PARENT PARTNER IS A PART OR FULL-TIME, NON-EXEMPT POSITION AND IS THEREFORE SUBJECT TO THE PROVISIONS OF THE FAIR LABOR STANDARDS ACT. Compensation: $20.00 - $22.00 per hour
Our philosophy is based on the concept that there are eight levels of intervention in community development to ensure successful prevention partnerships:
Strengthening individual knowledge
Promoting community education
Educating providers Fostering coalitions and networks
Changing organizational practices
Influencing policy and legislation
Minimizing barriers
Ensuring that affordable and appropriate services are accessible to pregnant women, infants and all individuals and families
Establishing public/private partnerships for coordinated community based care
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