Case Manager, Medicaid Long Term Support Program

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a
Case Manager, Medicaid Long Term Support Program
to join #TeamMVP. If you have a passion for advocacy, collaboration and problem solving and innovation this is the opportunity for you.

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 and one of the Best Companies to Work For in New York

Qualifications You'll Bring

• Current New York State Licensure as a Registered Nurse required.
• 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.
• 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.
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Your Key Responsibilities

• 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.
• 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.
• Service Authorization & Review: Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of LTSS services.
• Care Coordination: Collaborate with case managers, care coordinators, and providers to ensure integrated, person-centered care.
• Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (e.g., NCQA), including documentation and reporting.
• Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio (MLR).
• Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution.
• Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where You'll Be
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).

Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

We do not request current or historical salary information from candidates.

MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

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