Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!

There are some positions at MVP where your work may require an onsite or community component. When working in an MVP office and/or in the community on behalf of MVP, you must be fully vaccinated against COVID-19, and have received the first booster dose within one month of eligibility.

The Care Guide (CG) position at MVP was designed to be a clinical advocate and “first welcome” to MVP to support the transition to a new health plan. The Care Guide will work directly with members, members’ families and/or advocates to ensure that the member understands the resources available to them at MVP and to ascertain clinical needs and triage the member to MVP resources that support, promote, and facilitate engagement in MVP Care Management and Wellbeing Programs. The CG will work as a bridge between the customer, the health plan, and the customer’s provider to create a seamless and positive experience to fulfill their unmet care needs.The CG will build individual capacity by increasing health and wellness self-management skills and sufficiency through a series of activities such as outreach, education, informal counseling, social supports, and advocacy. The CG is responsible to address the needs and wishes of the member and his or her family and/or advocate and to support changes as they affect the member’s desired outcomes, quality of care and quality of life. The position will empower the member to make informed decisions and advocate on their behalf when deemed necessary.
The Care Guide will collaborate with a broader team multi-disciplinary clinical team, including but not limited to Care Management. In particular, the CG will support the member’s engagement with the plan through coordination with the Care Management pod structure/team and the Strategic Provider Partners in each of regions by assisting members in reducing/resolving challenges or barriers so that the member may achieve their optimal level of health, independence, safety, and well-being. In this role, the CG will communicate with the member to promote member engagement, utilization of Plan benefits to enhance their health and access while supporting overall satisfaction.

Responsibilities:

• New Member Welcome Calls/Transition to the plan
• Benefit review
• Plan transition – Minimize disruption and understand current clinical needs
• Screening for conditions/issues-Complete Health Risk Assessment
• Transitions of care- Could be new diagnosis, could be Post D/C, triage to MVP clinician as needed
• Transition of Care
• Care Navigation/Appropriate setting and network guidance and supporting Health Literacy so customers understand their needs and clinical solutions
• Family Support
• Triage to MVP clinical programs

Details/Specifics related to the above:

• Orient new members to specific product offerings and the services of the CG.
• Ensure the customer has a significant degree of understanding of benefits, eligibility for certain services, and talk through and coordinate transition of care items
• Promote Member understanding of their diagnosis and treatment plan
• Assist customers’ in addressing unmet needs recognizing that Members that have needs beyond their standard benefit coverages.
• Facilitate reduction of care disruption or delays in care.
• Facilitate access to services which are culturally appropriate, meet the member’s stated need for service and enhance the quality-of-service delivery.
• Promote knowledge of health delivery system(s) to empower member into self-care management.
• Support patient-centric strategies to improve health and wellness in collaboration with Care Managers and others. Collaborate with MVP Quality Management to support performance measurements. .
• Facilitate resolution of real and perceived disruptions of care as Member enrolls in MVP Medicare Advantage Product.
• The CG will perform other duties as assigned by management.

Knowledge & Skills:

• Ability to incorporate Evidence Based Innovation (EBI)
• Ability to collaboratively work with team to assist and resolve member concerns and complaints.
• Extensive knowledge and experience with community organizations, social services, and public resources.
• Willingness to meet directly with members, their families, advocates, in office, home settings or other as warranted by member.
• Working knowledge of Medicare, Medicaid, Commercial programs and products.
• Understanding of current health care market and products/resources available in the community. p
• Highly organized; capacity to work independently and able to manage multiple priorities appropriately; strong ability to do follow-up.
• Excellent ability to communicate independently and directly with members, providers and staff with calmness, assertiveness, diplomacy and in a non-confrontational manner with the goal being to engage successfully with customers
• Strong communication skills, both verbal and written.
• Proficient in computer skills
• Valid driver’s license and ability to travel as needed
• Ability to work independently and maintain flexibly in fast paced start up environment.
• Must have access to reliable daily transportation.

Qualifications:

• Bachelor’s Degree in a Health or Human Service field preferred
• Minimum of an Associate’s Degree in a health or human services field and three years of experience working within managed care or health services environment
• Experience in Managed Care and/or working relationships Medicare, Medicaid, or Social Service Agencies a plus.
• Clinical experience a plus

Spanish speaking communication (oral and/or written) is preferred

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 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. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com

Please apply and learn more – including how you may become a proud member of our team.


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