RN Team Leader - Population Health - Rochester or Schenectady
MVP Health Care - Rochester, NY

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Under the direction of the Supervisor of the Population Health, the Team Leader will act as a technical and navigational resource to the team, as well as a liaison between nursing staff, Medical Directors and MVP providers, especially related to areas where a knowledge deficit exists or in time sensitive situations. The Team Leader will identify opportunities for improvement, knowledge deficits and actual/potential problems. The Team Leaders will possess the ability to problem solve and appropriately refer to the Supervisor when necessary. The Team Leader will be knowledgeable of and able to interpret various contracts, policies and procedures and participate in meetings and projects as required. The Team Leader will assist the Supervisor in the preparation of reports, oversight of NYS and NCQA regulations including Quality Control and outcomes, and/or other functions as assigned. The Team Leader will maintain a case load, working with staff and participants to identify opportunities to improve the participant s current health care needs, to promote health and well being, and to assist the members in obtaining necessary health services. POSITION QUALIFICATIONS Minimum Education: Registered Nurse with current NYS License. BSN preferred or Social Worker (BSN) with current NYS License. Case Management Certification and or certified wellness coach certification preferred (if not certified at the time of hire must achieve within one year of hire) Minimum Experience: 2 years clinical experience in an acute care clinical setting. Minimum 1years case/disease management experience preferred. Required Skills: Solid foundation of knowledge and experience in case and/or condition health management strongly preferred. Proven knowledge and experience navigating case/condition health management and utilization management requirements, product variations, claims and appeals preferred.Excellent interpersonal skills including the ability to work successfully with a wide variety of people. Independent thought process; oriented toward probing and problem solving. Strong computer skills and knowledge required (including maxMC and Microsoft office products). Proven success in interacting with providers on delicate matters with providers, members, internal and external customers and staff. Excellent written and verbal communication skills. Ability to exercise discretion in handling confidential member information. Demonstrated willingness to function collaboratively in a team-oriented environment

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MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...