Rochester or Schenectady, New York - Posted on: Monday 09/16/13
Under the direction of the Director of Population Health Management:
Provides professional oversight, leadership and guidance of the Medicaid and Exchange programs. Responsible for
clinical operations and medical management activities across the continuum of care (assessing, planning, implementing,
coordinating, monitoring and evaluating). Assures compliance with all MVP, Federal, State and regulatory requirements.
Ensures the development, implementation, coordination, and evaluation of case management based activities and
interventions. Knows and interprets MVP contracts, policies and procedures. Acts as a liaison between the case
and condition health management teams and the strategic business units (SBUs), internal staff, Medical Directors,
community partners and other MVP service providers. Interacts with other departments to define data requests, test
system performance and evaluates/drives process improvement opportunities. Interacts with Member services, Provider
Relations, Quality Improvement, and Finance to identify utilization trends. Performs other duties as assigned.
- Registered Nurse and/or Licensed Social Worker is required. Bachelor’s degree in Nursing or Health
Management Administration preferred.
- Current Licensed Registered Nurse or Social Work with CCM Certification and/or Well Coaching Certification is
- 3-5 years experience in case, disease or utilization management is required
- 2-3 years of Leadership experience preferably as a supervisor of clinical or non-clinical staff
- Ability to work independently and prioritize multiple assignments to meet deadlines
- Highly effective interpersonal and conflict management skills
- Ability to use discretion in handling confidential information
- Excellent oral and written communication skills
- Organizational and Time Management skills
- Excellent Customer Service
- Strong analytical and critical thinking skills
- Knowledge of process development, systems management, policy development and workflow design
- Knowledge of chronic health conditions, evidence based practice guidelines and clinical tools used to
demonstrate compliance with practice recommendations
- Proven success interacting with sensitive health issues, medical necessity and service appropriateness
- Proficient in the use/application of standard computer applications (word, access, excel, power point).