Professional, Case Manager, Medicaid Long Term Support Program

MVP Health Care•Schenectady, NY

4d•Remote

About The Position

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. This 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 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. In addition, 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. Other duties as assigned by supervisor. 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).

Requirements

Current New York State Licensure as a Registered Nurse required.
At least 3 years of recent clinical and Case Management experience.
Experience with Medicaid programs and benefits strongly preferred
Ability to professionally communicate with members, and all interdisciplinary team members.
Excellent oral and written communication skills
Demonstrated clinical knowledge including an understanding of population health management and the case management process.
Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.
Ability to work in an energetic team environment.
Experience with situations requiring strict adherence to confidentiality.
Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.
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 plan of care and be able to demonstrate good judgment when dealing with emotionally charged situations.
Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access

Nice To Haves

Bachelor's degree in nursing preferred
Case Management Certification a Plus (ANCC or CCM)
Certification in Case Management required within 24 months after hire.
Experience working in a Medicaid Long Term Support Program (LTSS) or Health Home preferred.

Responsibilities

assessment
planning
implementation
care coordination
monitoring
advocacy
identify the medical and psycho-social needs of designated members
act as a proactive partner
provide appropriate education, coordination of care and resource allocation
engage individual members and communicate with an established interdisciplinary team
review of a comprehensive assessment and development of a time tasking tool and an individualized person-centered plan of care
provide guidance in understanding benefit coverage and navigating the health care delivery system
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
monitor and review cases with the Medical Director to ensure appropriate outcomes
Other duties as assigned by supervisor