MVP Health Care jobs in Rochester, NY

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, Quality Analyst** to join #TeamMVP. This is the opportunity for you if you have a passion for healthcare, innovation, and collaboration. **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** . **Qualifications** **you'll** **bring:** + Bachelor's Degree in Business, Math, Computer Science, Information Systems, related field or five or more years of related work experience. Master's degree preferred. + Minimum 3 years of analytics experience with large data sets required + 1 year of analytics experience with healthcare quality data highly preferred + Subject matter expertise in healthcare data- claims, coding, HIE's etc. Experience with quality metrics, (NCQA HEDIS and NYS QARR) standards strongly preferred + Strong analytical skills, with the ability to turn data into actionable insights + Proficiency in SQL, data visualization tools (e.g. Tableau, PowerBI) + Data Manipulation tools (e.g. Alteryx, R, Python) beneficial + Excellent verbal and written communication skills, with the ability to effectively communicate technical information to both technical and non-technical stakeholders + Intermediate Excel skills include entering and editing complex formulas, filtering lists, sorting ranges, and using data analysis tools (pivot tables, scenarios, etc.) + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Lead and oversee the successful execution of quality data deliverables. + Conduct analysis of large data sets to support quality improvement initiatives, including gap analysis, process optimization, and patient engagement. + Collaborate with cross-functional teams to design, implement, and maintain data solutions that meet the needs of stakeholders and business partners. + Ensure the accuracy and integrity of data through the development and implementation of data quality control processes and procedures. + Must also provide adequate documentation of how analysis was performed and be responsible for applying necessary checks and balances to ensure quality and accuracy of reports. + Participate in the development of data governance policies, standards, and procedures, and ensure compliance with regulatory requirements and industry best practices. + Present data insights and recommendations to leadership, effectively communicating complex technical information to non-technical stakeholders using visual aids (charts, graphs) or summaries. + Continuously monitor and evaluate the effectiveness of operational workflows, making recommendations for improvements and leading implementation efforts as necessary. + 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** **Quality Improvement** **Pay Type** **Salary** **Hiring Min Rate** **75,870 USD** **Hiring Max Rate** **139,136 USD**

Qualifications you'll bring: High school diploma Two years' experience in health insurance, medical, or healthcare field One year customer service experience The availability to work full-time, 3 days during the week and weekends required, virtually within NYS. Knowledge of Microsoft Outlook and Word Intermediate computer/keyboarding skills Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Handle service requests and correspondences from providers, facilities, enrollees, or their representatives via phone, fax, email, and postal mail. Review and interpret authorization requirements based on MVP contracts, riders, resources, policies, and procedures. Create authorization cases for service requests requiring authorization. Make outgoing faxes and/or calls to providers with determinations or to request additional information. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual within New York State. Tarrytown, New York; Schenectady, New York; Rochester, New York

will require coming into the Rochester, NY Office. The LTC Benefits Planner (Personal Care Advisor) has the responsibility of evaluating and managing those Insureds that are accessing their benefits based on their need for long-term care services. This includes ongoing evaluation of the Insured's eligibility for benefits, appropriateness of the plan of care, coordination of other insurance policies/providers, documentation and communication with Insured, Insured's family, care providers, and monitoring of claim submission and processing. All work is directed under the terms and conditions of the various individual insurance contracts. Essential Accountabilities: Level I Operates as a case advisor for Insureds accessing benefits under their LTC policy as key contact and advocate for Insured and their family. Independently manages a caseload of Insureds in accordance with time-service standards required by the Company. Evaluates Insured's condition through review of field assessments, medical records, etc. Determines benefit eligibility based on the criteria outlined in the LTC policy (contract). Develops and assists with appropriate plan of care for Insured. Provides referrals to external vendors to assist in putting care in place and managing private caregivers. Defines the services covered and not covered under the terms of the contract and assists with the arrangement of services as is deemed necessary. Evaluates submitted claims to determine if services billed and provided are consistent with the approved plan of care. Develops and documents alternate plans of care as deemed appropriate under the terms of the insurance contract. Reviews the Insured's benefit file and claim payment to encourage timely submission and adjudication of claims within company and State time service standards. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II - In addition to the essential accountabilities in level I Manages a larger and/or more complex caseload of Insureds while maintaining time-service requirements. Trains and mentors less experienced LTC Benefit Planners including interpretation of more difficult policy language. Provides guidance and leadership regarding the daily activities of department. Acts a resource to staff, management and vendors. Identifies and develops processes and guidelines for performance improvement opportunities for the Department. Expert and resource for escalations - Serves as subject matter expert and if called upon, works directly with the operation to resolve issues and escalated problems. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I: Three (3) years combined experience in insurance and/or a clinical setting. Active NYS RN License or bachelor's degree in social work or related field. In lieu of an RN or bachelor's degree, an associate's degree or LPN with a minimum of two (2) years' experience in long term care claims adjudication and two (2) years long term care customer service. Must have the ability to review and interpret medical records and assessments for the purpose of determining eligibility for benefits. Experience in long term care setting or with geriatric populations is preferred. Basic analytical and problem-solving skills. Ability to speak on confidential medical issues with customers. Must display a high degree of professionalism and have strong written and verbal communication skills. Attention to detail. A working knowledge of Microsoft Office applications is required. Skillful at working between multiple programs and applications at the same time. Level II Four (4) years combined experience in insurance and/or clinical setting, or the candidate must have a minimum of two years combined experience in the Level I position. Active NYS RN License or LMSW; or LCSW. Prior case management experience preferred. Ability to deliver efficient, effective, and seamless care to members. Demonstrates ability to escalate to management, as necessary. Demonstrates proficiency in all related technology and documentation requirements. Physical Requirements: Ability to travel across the Health Plan service region for meetings and/or trainings as needed. May require flexible hours to meet needs of member discussions. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E2: Minimum $60,410 - Maximum $96,081 Level II: Grade E3: Minimum $60,410 - Maximum $106,929 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

The Medical Director participates in the broad array of activities of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for our various lines of business. The incumbent also provides input into the development of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees and when assigned to other committees or workgroups as requested by leadership. They also act as a liaison with local physicians and hospitals and keep abreast of practice patterns, issues, and concerns of their regional medical community, as well as support our Provider Relations team as requested. This position is occasionally required to work evenings during high volume periods and staff shortages, e.g. cross-coverage vacations. Essential Accountabilities: Level I Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries. Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. Conduct clinical appeal case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. Provides clinical expertise on ARD cases, Quality of Care cases, clinical editing, coding reviews and inquiries. Makes accurate and consistent interpretation of integral medical policy, contract benefits and State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. Clinical skills are excellent and evidence-based medicine skills are such that the individual provides review oversight for a broad array of clinical services. Reviews and makes recommendations on medical policies, guidelines and medical criteria. Assists with training medical director colleagues and nursing staff, including leadership of teaching grand round activities, and case consistency conferences. Regular attendance at assigned meetings including, but not limited to, weekly Medical Director staff meetings, weekly case consistency meetings, monthly medical policy meetings, as well as, departmental and divisional meetings, including in person meetings. Serves as a resource and consultant to other areas of the company. May be required to represent the company to external entities and/or serve on internal and/or external committees. May chair company committees. May develop and propose new medical policies, in conjunction with Medical Services team and Medical Policy Department, based on changes in healthcare. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements. Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a mentor or coach to other Medical Directors and other colleagues in quality and performance improvement processes. Functions as a mentor and resource throughout the workday in training medical director colleagues, as needed. Conduct clinical appeal case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. Provides input into the utilization management program policies and procedures. Serves as a resource and consultant to other areas of the company. Assists in many aspects of frontline UM during high peak activity or staff outages. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels Minimum of seven (7) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable). Medical Degree: MD or DO from an accredited institution required. Active board certification in Professional Medical Specialty. Active unrestricted medical license to practice medicine in a state or territory of the United States Doctor of Medicine or Doctor of Osteopathic Medicine. The Physician is not the subject of any pending professional disciplinary action that could result in the impairment of their ability to practice medicine. Knowledge of applicable state and federal laws, NCQA standards, and Utilization Management. Demonstration of effective use of word processing, spreadsheet, email. Must be able to research clinical issues. Strong interpersonal skills essential for communication to staff at all levels of the organization. Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills. Ability to work within changing business environment and balance patient advocacy with business needs. Successful ability to assess complex issues, to determine and implement solutions, and resolve problems. Demonstrated sensitivity to culturally diverse situations, participants, and customers/members. Level II (in addition to Level I Qualifications) Minimum 2-3 years of experience in medical management, utilization review and case management. Knowledge of managed care products and strategies. Demonstrated ability to educate colleagues and staff members. Experience with managing multiple projects in a fast-paced matrixed environment. Demonstrated ability to educate colleagues and staff members. Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills. Knowledge of credentialing, quality, NCQA/HEDIS/CMS and/or Medicaid Star Ratings, and/or value-based payment programs is a plus. Strong verbal presentation skills to lead internal and external discussions including presenting at board level when requested. Previous experience managing physicians, nurses or employees preferred. Service marketing, sales and business acumen experience preferred. Physical Requirements: Ability to work prolonged periods sitting at a workstation and working on a computer. Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. Typical office environment including fluorescent lighting. Ability to work in a home office for continuous periods of time for business continuity. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Ability to lift, carry, push or pull 15 pounds or less. Manual dexterity including fine finger motion required. Repetitive motion required. The ability to hear, understand and speak clearly while using a phone, with or without a headset. ************ In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): SL1 Min: $223,200.00 - Max: $334,800.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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 **Graphic Designer** to join #TeamMVP. If you have a passion for creativity, collaboration and continuous improvement, 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** . **Qualifications you'll bring:** + BFA or a BA/BS in Graphic Design, Marketing, Advertising, Communications or other relevant field preferred, or Associates Degree in Graphic Design with a portfolio or comparable work experience. + The availability to work full-time, hybrid. + Minimum of 6-8 years' experience designing print and digital assets in a corporate setting, with health care industry experience a plus. + Ideal candidate will have experience as an in-house designer or at an ad agency designing for both business-to-business and business-to-consumer audiences. + Work samples are required to apply for this position. + 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:** + Design and develop a wide range of media including brochures, flyers, posters, ads, signage, direct mail, and digital assets (web, email, social media, presentations). + Contribute to concept development and marketing design strategies that support member communications and acquisition/retention efforts. + Champion the MVP Brand Guidelines to ensure every piece reflects a consistent look, tone, and feel. + Stay current with design software and digital trends, embracing new tools and ways of working. + Collaborate with internal teams and external vendors to manage projects from concept to completion - on time and on point. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Hybrid position, living within 50 miles from State Street in Schenectady or Rochester, NY. **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **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** **Marketing/Communications** **Pay Type** **Salary** **Hiring Min Rate** **69,383 USD** **Hiring Max Rate** **91,000 USD**

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a **Case Manager, Medicaid Long Term Support Program** to join #TeamMVP. If you have a passion for advocacy, collaboration and problem solving and innovation this is the opportunity for you. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home required. + Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the needs of medically complex Medicaid members. + Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner, and provide appropriate education, coordination of care and resource allocation. + The principal role of the position is to engage individual members and communicate with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care. + The position will provide guidance in understanding benefit coverage and navigating the health care delivery system. + The overall objective is to create solutions to overcome barriers to care and assist the member to achieve optimum health and/or improved functional capability through the coordination of quality cost effective care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Service Authorization & Review: Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of LTSS services. + Care Coordination: Collaborate with case managers, care coordinators, and providers to ensure integrated, person-centered care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (e.g., NCQA), including documentation and reporting. + Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution. + Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** This position may be worked either virtually (worked remotely from home) within a New York residency or at one of our office locations (Schenectady, Rochester, Tarrytown). **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Medical Management/Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200 USD** **Hiring Max Rate** **102,350 USD**

Qualifications you'll bring: High School Diploma or GED required; Associate's degree in Business or related field preferred. The availability to work full-time, virtual, in Schenectady or Rochester, NY 1-2 years of data entry or claims experience preferred. High accuracy and attention to detail. Strong data entry skills (5,000-7,000 keystrokes per hour preferred). Proficiency in Microsoft Word and Excel. Familiarity with medical terminology. 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: Perform continuous data entry of claim forms into internal systems from electronic images and paper documents. Manage and update non-par provider demographic information, including provider-initiated changes. Load new providers and maintain existing provider records in systems such as Facets and Macess. Ensure compliance with regulatory claim payment timeframes. Collaborate with internal departments to resolve data discrepancies and support provider data integrity. Maintain confidentiality and adhere to HIPAA and other regulatory standards. Meet or exceed departmental standards for productivity and quality. Adapt to changing business needs, including occasional overtime. 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 Schenectady, NY or Rochester, NY

Qualifications you'll bring: Bachelor's degree of applicable study with minimum of 3 years of experience in Health Care Analytics role or Advanced degree in math or statistics, and at least 1 year of experience working with Health Care data Working knowledge of Provider Billing/Reimbursement methodologies Foundational knowledge of MVP's markets and products and awareness of competitive landscape Working knowledge of MVP Data assets including claim, pharmacy, member and provider data Proficiency in SQL and Microsoft suite of products including Power Platform 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: Collaboration with team leader, peers and key stakeholders across the organization Research and query multiple data sources, manipulate large sets of data using appropriate tool Identify and implement the most efficient solution for the business problem with forward thinking mindset to leverage automation and efficiency Leverage AI, Machine Learning or Statistical software where appropriate to advance analytics Validation of data, data models and reporting for accuracy and soundness Actively seek to draw inferences from the data to drive actionable insights/strategic discussions Actively seek to understand the why and how to add value to business request vs. just doing the request Actively challenge the status quo and find a better way Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Location: remote within New York State

Qualifications you'll bring: Associate's or Bachelor's degree in a related field (e.g., healthcare administration, business, or HR) preferred. 2+ years of experience in credentialing, compliance, or quality assurance. Experience in healthcare or insurance credentialing preferred. Strong attention to detail and analytical skills. Familiarity with credentialing software and databases. Knowledge of regulatory standards (e.g., NCQA, URAC, Joint Commission) is a plus. Excellent communication and organizational skills. Ability to work independently and collaboratively in a fast-paced environment. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Understanding of data privacy and confidentiality standards. 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: Conduct thorough quality control reviews of credentialing/recredentialing files and documentation. Verify credentials, licenses, certifications, and other required documentation for accuracy and compliance. Collaborate with credentialing specialists to resolve discrepancies and ensure timely updates. Maintain detailed records of QC findings and corrective actions. Assist in developing and refining QC procedures and checklists. Monitor compliance with internal policies, accreditation standards, and regulatory requirements. Provide feedback and training to credentialing staff on quality standards and best practices. Support audits and reporting requirements related to credentialing activities. Stay current with industry standards, regulations, and credentialing best practices. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Hybrid

Qualifications you'll bring: A Bachelor's degree in a relevant field or equivalent combination of education and experience. At least 3+ years of enterprise-level content management experience. Advanced proficiency in HTML, CSS, JavaScript, and experience with CMS platforms like Sitecore. Familiarity with SEO, CRO, UX/UI principles, and digital analytics tools (GA4, Tag Manager, SEMrush). Experience with email marketing and automation using Microsoft Dynamics. Curiosity to foster innovation and pave the way for growth. Humility to play as a team. Commitment to being the difference for our customers in every interaction. Your key responsibilities: Manage stakeholder requests through ticketing systems like Microsoft Lists, Azure DevOps, and Jira. Update and maintain website content using Sitecore CMS, ensuring accuracy and brand alignment. Collaborate with internal SMEs to publish and optimize web content. Monitor and improve site performance using GA4, Tag Manager, Pagespeed Insights, and SEMrush. Support A/B testing initiatives and conversion rate optimization strategies. Build email and outbound campaigns using Microsoft Dynamics. Identify and resolve front-end issues including broken links and accessibility concerns. Apply HTML, CSS, and JavaScript to enhance usability and user experience. Collaborate cross-functionally with Development, IT, and other teams for timely updates. Maintain documentation of web processes and technical fixes. Contribute to our humble pursuit of excellence by performing various .responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Hybrid in Rochester or Schenectady, NY

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 an **Associate, Provider Service Representative** to join #TeamMVP. This is the opportunity for you if you have a passion for healthcare, customer service, and compliance. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll bring:** + High School diploma or equivalent when possesses customer service employment experience. + Minimum 1 - 3 years customer service experience and/or relevant office experience required. + Availability to work Monday- Friday from 8:30am- 5:00pm + Strong problem-solving skills with effective oral and written communication skills + Have strong interpersonal skills and exhibit good judgment + Demonstrated excellent customer service skills including superior accountability and follow through + Demonstrated PC skills using Microsoft applications + 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:** + The Associate, Provider Member Service Representative is responsible for responding to all Department of Health audit calls on a consistent basis. + Acts as a liaison between our internal and external customers. + Responds promptly, accurately, and effectively to all calls in a polite and professional manner. + Responds to all calls timely and have a clear understanding of call avoidance, such as but not limited to short calls, intentional disconnects, inappropriate transfers and inappropriate use of hold button. + Performs data input in a highly accurate and timely manner on all customer contacts. + Simultaneously accesses multiple databases while addressing customer's needs. + Clearly explains all policies and procedures on both incoming and out-going calls. + Develops a comprehensive understanding of all lines of business. Has the technical skills required to be able to perform task efficiently. + Delivers information in a clear and confident manner + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Location: Virtual. Please note all candidates must be located in New York State within a 40- mile radius from the Schenectady, NY; Rochester, NY; Tarrytown, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **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** **Customer Service** **Pay Type** **Hourly** **Hiring Min Rate** **20 USD** **Hiring Max Rate** **28.8 USD**

Qualifications you'll bring: An AA/AS or BA/BS in a technical discipline, Computer Science preferred. IT certification, such as A+, MCDS, or equivalence experience as a deskside support technician or similar role The availability to work on-site, full-time. 3+ years Computer Hardware experience required 3 years customer service experience Proven experience in providing technical support and problem solving/troubleshooting skills in an office environment. Microsoft 365 Cloud Platform (Intune/Entra/Azure) Experience with Windows 10/11 Proven experience in providing technical support and problem solving/troubleshooting skills in an office environment. Strong knowledge of computer hardware, software, and operating systems. 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: Provide deskside support to office staff, resolving technical issues and troubleshooting problems in a timely manner. Install, configure, and maintain hardware and software, including computers, printers, and other office equipment. Collaborate with the Digital team to implement and maintain security measures, ensuring the protection of sensitive data and information. Assist in the setup and configuration of new workstations, ensuring they are properly connected to the network and have the necessary software installed. Conduct regular maintenance and updates on office technology, ensuring optimal performance and minimizing downtime. Train office staff on the proper use of technology and software applications, promoting efficiency and productivity. Document and track technical issues and resolutions, maintaining accurate records for future reference. Stay up-to-date with the latest technology trends and advancements, continuously improving your technical skills and knowledge. Other duties as assigned by leadership. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Onsite- Rochester, NY Office

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

Qualifications you'll bring: Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered. Coding certification, such as AAPC CPC, CIC, COC, CCS is required. The availability to work full-time, virtual in New York State A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience. Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies. Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details. Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Manage recurring audit inventories, ensuring timely progression and completion of existing audits. Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews. Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types. Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education. Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization. Assist in the reporting of monthly metrics and participate in cross-functional audit operations. Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts. Participate in training and development activities within the department and corporation. Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. Perform research using "best practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual within New York State #cs

Qualifications you'll bring: High School Diploma required. Associate degree in health, Business or related field preferred The availability to work Full-Time, Virtual within New York State Previous related health care experience required Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. 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: Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Knowledge of Facets and Macess systems strongly preferred, but not required. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. Meets or exceeds department quality and work management standards for claims adjudication. Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. Keeps abreast of all benefit changes. 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, Rochester or Schenectady, NY

Qualifications you'll bring: High school diploma or equivalent required Minimum of 3 years' current experience in healthcare setting or a related field required Strong attention to detail and ability to manage multiple tasks simultaneously. Excellent communication skills, both written and verbal. Exceptional customer service skills and ability to handle difficult situations with empathy and professionalism. Proficient in using computer systems and software, including Microsoft Office Suite. Ability to work independently and as part of a team in a fast-paced environment. Strong organizational and time management skills. Knowledge of medical terminology and healthcare documentation standards 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: Provide administrative and operational support for post-acute care program. Coordinate communication between internal teams, skilled nursing facilities, inpatient rehabilitation facilities, and home health agencies. Work closely with internal and external stakeholders to support clinical documentation, ensuring accuracy and compliance with organizational and regulatory requirements. Assist with data entry, reporting, and tracking patient transitions and utilization metrics. Review documentation for completeness ensuring compliance (e.g.: CMS, Medicaid, NCQA). Support quality improvement initiatives and process enhancements. Serve as a resource for post-acute workflows and escalate issues as needed. Other duties as assigned. 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

This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care delivery processes. Ensures compliance with corporate and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director. Utilizes appropriate communication techniques with members and providers to obtain clinical information, assesses medical necessity of services, advocating for members in obtaining needed services, as appropriate, interacts with the treating physician or other providers of care. Collaborates with hospital, home care, care management, and other providers effectively to ensure that clinical needs are met and that there are no gaps in care. Acts as a resource and liaison to the provider community in conjunction with Provider Relations, explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise interacts with Health Plan programs and services. Makes accurate and consistent interpretation of required clinical criteria, medical policy, contract benefits, and State and Federal Mandates. May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and Corporate Medical Policies. Accountable for meeting departmental guidelines for timeliness, production and metrics and meeting requirements established for audits to ensure adherence to regulatory and departmental policy/procedures. Maintains compliance with all regulatory and accrediting standards. Keeps abreast of changes and responsible for implementation and monitoring of requirements. Assists with training and special projects, as assigned. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) Offers process improvement suggestions and participates in the solutions of more complex issues/activities. Mentors staff and assists with coaching, as necessary. Provides consistent positive results on audits. Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health. Manages more complex assignments; cross-trained to review various levels of care and/or services. Participate in committees and lead when required Level III (in addition to Level II Accountabilities) Displays leadership and serves as a positive role model to others in the department. Identifies, recommends and assesses new processes to improve productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. Assists in updating departmental policies, procedures, and desk level procedures relative to the functions Expert and resource for escalations - Serves as subject matter expert and if called upon, works directly with the operation and clinical staff to resolve issues and escalated problems. Mentor (to others in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to Utilization Management staff, members and providers. Provides backup for the Supervisor, whenever necessary. Participates in the orientation of new staff and/training opportunities for all staff. Assists staff to identify opportunities to successfully engage members into care. Assists Medical Director (MD) in projects as needed. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels Associates degree and active NYS RN license required. Bachelors degree preferred. Minimum of three years of clinical experience required. Utilization Management experience preferred. Must demonstrate proficiency with the Microsoft Office Suite Demonstrates general understanding of coding standards Maintains current and working knowledge of Utilization Management Standards. Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) and benefits, preferred. Strong written and verbal communication skills Ability to multitask and balance priorities. Must demonstrate ability to work independently on a daily basis. Deliver efficient, effective, and seamless care to members. Level II (in addition to Level I Qualifications) Minimum of 2 years in utilization management position. Demonstrates ability to escalate to management, as necessary. Demonstrates proficiency in all related technology Ability to take on broader responsibilities Ability to participate in training of new staff Level III (in addition to Level II Qualifications) Must have been in a utilization management position or similar subject matter expert for at least 5 years. Broad understanding of multiple areas (i.e. UM and CM). Incumbent is required to know multiple functional areas and supporting systems. Expert in Utilization Management and ability to handle complex assignments, challenging situations and highly visible issues. Ability to lead the training of new staff. Demonstrated presentation skills. Physical Requirements: Ability to travel across the health plan service regions as needed. Ability to work at a computer for prolonged periods of time. ************ One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A. for our communities. At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity. We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply. OUR COMPANY CULTURE: Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade E2: Minimum $60,410 - Maximum $96,081 Level II: Grade E3: Minimum $60,410 - Maximum $106,929 Level III: Grade E4: Minimum $65,346 - Maximum $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Qualifications you'll bring: Bachelor's degree in a related field (e.g., nursing, social work). Certified Case Manager (CCM) is required within 2 years of employment. Previous experience in care/case & disease management or a related healthcare role. Strong assessment and care planning skills. Knowledge of healthcare systems, insurance processes, and community resources. Ability to prioritize and manage multiple cases simultaneously. Strong problem-solving and critical-thinking abilities. Compassionate and empathetic approach to client care. Knowledge of Transition of Care (TOC) Knowledge of HEDIS & Quality Measure Knowledge of Government Programs 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: Conduct thorough assessments of client needs and develop individualized care plans. Coordinate and facilitate access to appropriate healthcare services and resources. Collaborate with healthcare providers, insurance companies, and other stakeholders to ensure seamless care coordination. Monitor client progress and adjust care plans as needed. Provide education and support to clients and their families to promote self-management and empowerment. Maintain accurate and up-to-date documentation of client interactions and interventions. Participate in case conferences and team meetings to discuss client progress and develop strategies for improvement. Stay current with industry trends and best practices in case management. 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

Qualifications you'll bring: High School Diploma or GED equivalent required Excellent organizational, communication, and time management skills Ability to quickly learn new software/applications Strong proficiency in problem solving and analysis Adaptability and flexibility in a changing environment required Ability to follow-up on tasks Excellent verbal and written communication skills Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Gather all contracts from various locations (shared drives, email attachments, physical files) into one central location. Migrate older paper contracts to digital, searchable versions. Implement a consistent approach to file naming to ensure easy retrieval and organization. Categorize contracts based on type, provider/health system name, effective dates, renewal terms, contract manager, and key clauses using metadata tagging. Set up access controls to limit who can view, edit, or manage specific contracts. Where you'll be: Location: On-site, Rochester NY #CS