Case Manager, Medicaid Long Term Support Program

3 days ago


Schenectady, New York, United States MVP Health Care Full time
Job Summary

MVP Health Care is seeking a skilled Case Manager to join our team. As a Case Manager, you will be responsible for utilizing an integrated utilization management and case management model to meet the needs of medically complex Medicaid members.

You 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 this position is to engage individual members and communicate with an established interdisciplinary team.

The Case Manager will review a comprehensive assessment and develop a time tasking tool and an individualized person-centered plan of care. Additionally, 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.

Responsibilities
  • Utilize an integrated utilization management and case management model to meet the needs of medically complex Medicaid members
  • Identify the medical and psycho-social needs of designated members and provide appropriate education, coordination of care and resource allocation
  • Develop 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
  • Coordinate quality cost-effective care to assist members in achieving optimum health and/or improved functional capability
Requirements
  • Current New York State Licensure as a Registered Nurse required
  • Bachelor's degree in nursing preferred
  • Case Management Certification a Plus (ANCC or CCM)
  • 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
  • Experience with Medicaid programs and benefits strongly preferred
About MVP Health Care

MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. We are committed to the complete well-being of our members and the communities we serve.

We offer a comprehensive benefits package, including competitive employee compensation and benefits packages, paid time away from work, 401(k) employer matching and profit-sharing program, low premium health benefits, life insurance and disability coverage, and an array of optional benefit plans.



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