Professional Case Manager

4 weeks ago

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

This position will utilize the essentials of an integrated Case Management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the member's comprehensive health needs. Through collaborative efforts, the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner to provide appropriate education, resources, and healthcare coaching. The principal role of the position is to engage individual members and communicate with an established interdisciplinary team to create an individualized person-centered care plan. In addition, the position will provide guidance in understanding benefit coverage and navigating the healthcare delivery system, including but not limited to Medicaid and Medicare benefits. The overall objective is to create solutions to overcome barriers to care and assist members 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.

Key Responsibilities:
  • Assess and identify the medical and psycho-social needs of designated members.
  • Develop and implement individualized care plans to meet the member's comprehensive health needs.
  • Provide education, resources, and healthcare coaching to members.
  • Communicate with interdisciplinary teams to ensure effective care coordination.
  • Monitor and review cases with the Medical Director to ensure appropriate outcomes.

Requirements:
  • Current New York State Licensure as a Registered Nurse is required.
  • Possession of Vermont licensure is preferred but can be obtained post-hire.
  • RN with multiple state licenses is preferred.
  • Bachelor's degree in nursing preferred.
  • Case Management Certification preferred (ANCC or CCM).

Preferred Qualifications:
  • At least 3 years of recent clinical and Case Management experience.
  • Experience with Medicaid and Medicare programs and benefits strongly preferred.
  • Certification in Case Management required within 24 months after hire.

About MVP Health Care:

MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve.

Benefits:
  • Competitive salary range: $82,000.00 - $97,110.60.
  • Considerable paid time away from work including PTO, sick time, service time off, paid holidays, and floating holidays.
  • Competitive 401(k) employer matching and profit-sharing program.
  • Low premium health benefits including medical, dental, and vision coverage.
  • Life insurance and disability coverage.
  • Full tuition reimbursement for approved courses and programs.
  • Best-in-class employee Well-Being program.

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