Case Manager for Medicaid Long Term Support

7 days ago

Schenectady, NY, United States MVP Health Care Full time

At MVP Health Care, we are dedicated to creating a healthier future for all by fostering innovative thinking and continuous improvement. We are excited to welcome a Case Manager for Medicaid Long Term Support to join #TeamMVP. If you have a passion for advocacy, collaboration, problem-solving, and innovation, this is the perfect opportunity for you.

What we offer:

  • Opportunities for career growth and advancement.
  • A people-centric culture that embraces diverse perspectives and backgrounds.
  • Competitive compensation and a comprehensive benefits package focused on your well-being.
  • The chance to shape the future of health care with a team recognized as a Best Place to Work and one of the Best Companies to Work For in New York.

What you bring:

  • Current New York State Licensure as a Registered Nurse is required.
  • Certification in Case Management within 24 months of hire.
  • At least 3 years of recent clinical and Case Management experience, with a focus on Medicaid Long Term Support Program (LTSS) or Health Home.
  • Ability to demonstrate understanding of clinical and psychosocial issues affecting treatment plans.
  • Curiosity to innovate and willingness to contribute to team success.
  • Commitment to making a positive impact for our customers in every interaction.

Your key responsibilities include:

  • Utilizing an integrated model for evaluation and case management to address the needs of medically complex Medicaid members.
  • Collaborating with an interdisciplinary team to assess and meet both medical and psychosocial needs of members.
  • Developing person-centered plans of care based on comprehensive assessments.
  • Guiding members through understanding benefit coverage and navigating the healthcare system.
  • Overcoming barriers to care to enhance members' health and functional capabilities.
  • Monitoring and reviewing cases with the Medical Director to ensure positive outcomes.
  • Conducting reviews to assess the medical necessity of LTSS services.
  • Coordinating care among case managers, care coordinators, and providers.
  • Ensuring compliance with Medicaid, Medicare, and accreditation standards.
  • Monitoring service utilization for cost-effectiveness and managing Medical Loss Ratio (MLR).
  • Participating in appeals for denied services and ensuring timely resolution.
  • Educating staff and providers regarding protocols and clinical guidelines.

Where you'll work:

This position may be worked either virtually from your residence in New York or at one of our office locations in Schenectady, Rochester, or Tarrytown.

Pay Transparency:

At MVP Health Care, we are committed to offering competitive compensation and benefits. The base pay range reflects our good faith estimate at the time of posting, and individual offers will be based on various factors including experience and geographical location.

MVP's Inclusion Statement:

At MVP Health Care, we believe in creating healthier communities by nurturing a diverse workplace. We strive to ensure all individuals from various backgrounds and walks of life have a voice and can thrive in our organization. Everyone's unique perspectives contribute to our creativity and collaboration.

MVP is an equal opportunity employer and promotes diversity without discrimination based on various classifications.

To maintain a safe and drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you need accommodations during the application process due to a disability, please reach out to our Talent team.

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