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Burlington Office, 62 Merchants Row, Williston, VT, USA ● Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA ● Virtual ● Req #2001Wednesday, April 24, 2024Professional SME responsible for claim trend analytics and cost containment program evaluation and measurement across all Markets. Cost containment evaluations can include but will not be not limited to programs/policies related to medical management, clinical edits, provider payment and pharmacy policies. Professional will participate in content creation for Monthly Trend Report Out for Business Leadership that informs key drivers of claims trends and opportunities for exploration / reme ...Read more about Health Care Economics AnalystMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Req #1911Wednesday, April 24, 2024Are you willing to be in the community, developing relationships to foster MVP growth? Do you understand customer unmet needs and how to differentiate product offerings? Are you an impact-oriented, collaborative leader who learns quickly, embraces change, and can see around corners? Do you have a knack for asking the right questions and holding others accountable? If you are a persuasive problem-solver with a strong sense of urgency and a desire to make an impact, then this position may be p ...Read more about Vice President Government ProgramsMore
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Burlington Office, 62 Merchants Row, Williston, VT, USA ● Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA ● Virtual ● Req #1914Tuesday, April 23, 2024Full-Time, Exempt Position is remote/virtual Responsible for state and federal submissions in an accurate and timely manner. Accountable for regulatory reporting within the organization and government entities. Reconciling encounter data and providing root cause analysis of rejections with member eligibility, provider, medical & pharmacy data elements, and claim payment information. Continuously monitor the statuses of existing processes and identify discrepancies or process improvements. Ac ...Read more about Technical Business Analyst, Encounter Data Integrity & DeliveryMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Req #1988Friday, April 19, 2024Responsible for performing analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations. Analytical lead on various prospective and retrospective objectives in population health management including operational focus on Risk Adjustment efforts. Lead co-workers on design targeting based upon disparate data sources to identify members with likely risk gaps across. Provide regular reporting of Risk Adjustment programs and identify opportunities and obstacles. Meas ...Read more about Senior Population Health AnalystMore
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625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Vermont, USA ● Req #1987Thursday, April 18, 2024Status: Non-Exempt This position will help licensed pharmacists take care of many of the daily operations of the pharmacy department. Individuals in this fast-paced, frequently changing regulatory position will be responsible for: calling providers, members, and pharmacies; having knowledge of pharmacy benefits (medical and retail-based) for MVP’s multiple lines of business (Medicare/Commercial/Medicaid/etc.), multiple formularies and associated policies and staying on top of ongoing regulato ...Read more about Associate, Pharmacy SpecialistMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA ● Virtual ● Req #1932Thursday, April 18, 2024The Actuary will support the functions/tasks of the Actuarial Department in a more advanced and independent capacity. The functions include any of the following: premium rate development and regulatory filings, financial forecasting, experience studies, monthly reserve setting, provider risk sharing analytics/contracting, model development and other duties as assigned. The Actuary will be proficient in use and knowledge of large databases, Datamarts advanced excel modeling, SQL coding a ...Read more about Actuary AnalystMore
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625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Virtual ● Req #1977Thursday, April 11, 2024Status: Full Time, Exempt MVP’s Quality department focuses on improving the clinical well-being of MVP members by focusing on improving key metrics of care. The Quality department is seeking a fast paced, organized, and driven candidate for the position of Medicare Stars Quality Program Manager. This position will direct report to the Leader, Medicare Stars Quality Performance & Initiatives and will support program-level activities to ensure the goals are achieved. Achieves Medicare Stars obje ...Read more about Professional, Medicare Stars Quality Program ManagerMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Req #1979Thursday, April 11, 2024We are continually evolving the way MVP uses technology to grow our business, digitally transforming the organization using modern technologies and platforms (.NET Core, React, Azure, etc). The Customer Experience Team is a critical part of the digital transformation, managing and driving roadmap development for MVP digital product(s). The Product Management Intern will serve an important function within our Customer Experience team at MVP to help drive best in class experiences for our custom ...Read more about Product Management InternshipMore
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Fishkill Retail Outreach, 300 Westage Business Center Drive, Fishkill, NY, USA ● Headquarters Office, 625 State Street, Schenectady, NY, USA ● Req #1976Tuesday, April 9, 2024This Large Group Commercial Sales Professional develops, manage, and enhance relationships within MVP's broker distribution channel to support commercial growth within target markets and products. Attends appropriate business functions to promote MVP and establish contacts in assigned communities. Responsible for achieving assigned new business sales goals by writing new large group cases through brokers, consultants, and direct sales activity. Analyzes and assesses existing competitor emplo ...Read more about Sales Executive – Large Group Employee BenefitsMore
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220 Alexander St, Rochester, NY 14607, USA ● 303 S Broadway # 230, Tarrytown, NY 10591, USA ● 625 State St, Schenectady, NY 12305, USA ● Vermont, USA ● Req #1962Tuesday, April 9, 2024Status: Full Time, Exempt Provides professional oversight, leadership and guidance over the day-to-day operation of the Utilization Management (UM) Prospective and Retrospective leaders and teams. Assures compliance w/ Federal, State, NCQA, other regulatory agencies, & internal standards & requirements. Keeps current on all state and federal regulations affecting UM activities. Monitors UM literature at the state and national level to ensure that MVP remains at the forefront of effective memb ...Read more about Leader, Physical Health Prospective and Retrospective UMMore
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Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA ● Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Tarrytown Office, 303 South Broadway, Tarrytown, NY, USA ● Req #1966Friday, April 5, 2024As a successful Leader of this high-performing team, you’ll be focused on increasing digital adoption through innovation, social media, and content marketing using data to make informed decisions that deliver personalized and high-converting engagements. Areas of digital marketing oversight include digital content strategy, content execution, and branding across multiple domains and audience segments, marketing automation strategy and execution, lead generation tools, digital analytics, paid and ...Read more about Leader of Digital Marketing & AnalyticsMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Req #1967Friday, March 29, 2024Full-time, Exempt. Hybrid to Schenectady N.Y. The Compensation Analyst will support compensation processes within the Total Rewards HR Function and will actively contribute to the execution of key deliverables. The role’s primary accountability will be to support the calculation and administration of all company sales incentives, including but not limited to—Commercial, Government Programs, and Recruitment. This position will partner with both Sales Leadership and Sales Operations to ensure pa ...Read more about Professional, Compensation AnalystMore
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Dutchess County, NY, USA ● Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA ● Orange County, NY, USA ● Sullivan County, NY, USA ● Ulster County, NY, USA ● Req #1968Thursday, March 28, 2024Individual Product Advisor is responsible for membership growth in strategic target areas, identifying eligible members and enrolling them in Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), and HARP as well as enrolling consumers in Off-Exchange and Medicare Advantage (MA) products including D-SNP (Dual Special Needs Plan) as permitted under federal and state guidelines. Provides guidance on plan benefits and care tailoring those to customer needs. Individual Produ ...Read more about Individual Product Advisor - FishkillMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Virtual ● Req #1926Monday, March 25, 2024Full-Time, Exempt Provide advanced network architectural design and support for MVP’s current and future network infrastructure. Lead in the design and implementation of network strategies, roadmaps and architectures to enable a secure and scalable network infrastructure. Lead or consult on complex technology projects requiring deep subject matter expertise in various fields of specialization, such as security, cloud, and network monitoring. Requirements Proficient in creating networ ...Read more about Senior Network ArchitectMore
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220 Alexander St, Rochester, NY 14607, USA ● 303 S Broadway # 230, Tarrytown, NY 10591, USA ● 625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Req #1964Wednesday, March 20, 2024Status: Full Time, Exempt Under the direction of the Leader of Case Management, the Behavioral Health Case Manager will provide education and support to customers with behavioral health conditions. The Behavioral Health Case Manager will be responsible for improving health outcomes of and promoting appropriate preventive care for MVP’s members with behavioral health conditions. MVP’s Behavioral Health Case Manager will coordinate care during hospitalizations and post discharge, to assist our ...Read more about Case Manager Behavioral HealthMore
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Status: Full Time, Exempt This position will be responsible for supporting the City of Rochester employee wellness strategy both in development and execution of programs. Additionally, this position will support improving the health of the Greater Rochester Community through creative and impactful wellness and well-being programming that aligns to the Mayor of Rochester’s community wide focus areas. ESSENTIAL JOB FUNCTIONS: Develop meaningful and impactful programs and i ...Read more about Health Promotion Program ManagerMore
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Burlington Office, 62 Merchants Row, Williston, VT, USA ● Fishkill Office, 300 Westage Business Center Drive, Fishkill, NY, USA ● Headquarters Office, 625 State Street, Schenectady, NY, USA ● Rochester Office, 20 S. Clinton Ave, Rochester, NY, USA ● Virtual ● Req #1838Tuesday, March 19, 2024Full-Time, Exempt. Position is remote/virtual The role includes but is not limited to the following: Leverage DevOps concepts that promote good quality and automation practices. Create detailed, comprehensive, well-structured test cases that are automatable. Create system or business process flow diagrams. Utilize structured query language (SQL) for data mining and data seeding purposes. Identify critical path regression scenarios. Conduct root cause analysis and participate in debugging act ...Read more about Quality Engineer - MobileMore
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625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Virtual ● Req #1936Wednesday, March 13, 2024Status: Full Time, Non-Exempt The bilingual representative provides optimum customer service as required to maintain existing members and prevent cancellations. Address member, internal and external customer inquiries, questions and concerns in areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care across a variety of insurance types. Meet individual accessibility and quality goals, and team goals for industry standard benchmarks such as Average ...Read more about Bilingual Member Services Associate, Care Center RepresentativeMore
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Headquarters Office, 625 State Street, Schenectady, NY, USA ● Req #1916Thursday, February 29, 2024Hybrid to Schenectady, New York. Senior Director of Vendor Management is a key leader in the vendor ecosystem. The leader will work with business owners across the organization to ensure alignment to our values, and excellent member experience, and value to our customers and MVP. This position provides oversight for strategic vendor agreements beginning with a deep understanding and focus on execution of the strategies and goals for each vendor engagement. Working closely with business ow ...Read more about Senior Director, Vendor ManagementMore
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220 Alexander St, Rochester, NY 14607, USA ● 303 S Broadway # 230, Tarrytown, NY 10591, USA ● 625 State St, Schenectady, NY 12305, USA ● Req #1915Tuesday, February 20, 2024Status: Full Time, Exempt To provide MVP members enrolled in the Medicaid Long Term Support Program with the psychosocial support needed to cope with chronic, acute, or disabling conditions. The Social Worker will telephonically assess, identify needs, coordinate, educate, case manage and/or coach members. Services include providing member education and counseling, making necessary referrals to social service programs, and coordinating necessary services for MVP members in the Medicaid LTSS pr ...Read more about Social Worker, Medicaid Long Term Support ProgramMore
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625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Req #1770Tuesday, October 17, 2023Status: Full Time, ExemptThe Clinical Coordinator (CC) will work directly with customers, their families and/or advocates to ensure that the member has access to MVP resources offered through the Long-Term Support and Services (LTSS) Program. The CC works collaboratively with the RN case manager to support, promote, and facilitate engagement in the LTSS Case Management Program. The CC will work as a bridge between the customer, the health plan, and the Community based Organizations to create a ...Read more about Professional, Clinical Coordinator LTSSMore
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625 State St, Schenectady, NY 12305, USA ● Rochester, NY, USA ● Tarrytown, NY, USA ● Req #1769Tuesday, October 17, 2023Status: Full Time, ExemptThis position will 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 resou ...Read more about Case Manager, Medicaid Long Term Support ProgramMore