CDPHP

Job Description: This position helps support the health plan's comprehensive medication management program through proactive identification of high-impact members who are utilizing high-cost specialty medications. The role plays a critical part in executing pharmacy-driven cost reduction strategies, including support of stop-loss initiatives, while ensuring clinically appropriate and member-centered care in collaboration with providers, members, pharmacies, and internal teams. Under the direction of Pharmacy Care Coordination leadership, this role is responsible for evaluating cost effective treatment regimes, with a focus on optimizing specialty medication use, improving member outcomes, and reducing total cost of care. Essential Accountabilities: Level I Utilizes prescription and medical claim data to generate clinical recommendations and conduct comprehensive medication reviews for members, with a focus on high-cost specialty therapies and complex drug regimens....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: This position acts as a quality improvement liaison with physician offices, community agencies, hospitals, and members to promote care management and quality programs. Acts as a member advocate by addressing gaps and barriers to care and educate appropriate use of services through outreach and pilot opportunities. The incumbent promotes programs and services available to Excellus members. Essential Accountabilities: Level I Explores multiple sources of information to identify members who have a gap in care, aligning with HEDIS quality measures and Value Base Payment programs. Assesses member's needs by applying Health Plan approved guidelines and assessment tools. Makes appropriate referrals to clinical programs. Provides outreach and education via telephone and written communication for members on health care quality metrics, assesses barriers to care, and intervenes as appropriate to assure access or facilitate referrals to other services for the...

Job Description: Summary The Affordability Portfolio Manager is responsible for supporting the operational governance, administration, and portfolio management activities that enable successful execution of the Health Plan's affordability strategy. This role serves as a central coordination and accountability point for affordability initiatives, ensuring opportunities progress efficiently through ideation, evaluation, approval, implementation, measurement, and ongoing monitoring. The role drives organizational effectiveness by facilitating governance processes, maintaining portfolio visibility, supporting executive communications, and promoting accountability across cross-functional teams. Acting as the operational backbone of the affordability function, the Portfolio Manager ensures affordability initiatives are prioritized, tracked, measured, and communicated effectively to stakeholders and leadership. Essential Accountabilities: Level I Establish and lead...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Manager of Operational Performance & Workforce Optimization (OP&WO) is responsible for executing multiple operational performance and workforce management strategic and reporting initiatives. This role provides oversight to any performance and workforce optimization initiatives for the operations functional areas and supports operations functional areas on any corporate workforce management projects. In addition, this position directly supports the operational leadership team with system performance analysis, process improvement development & identification and execution of business plans. Two Positions Available: - Manager of Operational Performance & Workforce Optimization (Capacity Planning & Customer Insights) - Manager of Operational Performance & Workforce Optimization (Metrics & Reporting Solutions) Essential Responsibilities/Accountabilities: • Provides leadership to an internal team of operational...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Senior Medical Director is a strategic clinical and business leader responsible for advancing the health plan's line of business focus through value-based care, population health, medical management, quality improvement, risk adjustment, product design, and clinical transformation. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements. Essential Accountabilities: Serve a senior clinical advisor to line of business leadership on strategy, population health, medical cost, quality, and regulatory priorities, develop and execute clinical strategy in alignment with organizational growth, quality, and financial objectives. Identify clinical and market opportunities to improve member...

Job Description: Job Description Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours...

Job Description: Summary: Under the direction of assigned management, the Legal Counsel functions as a strong legal generalist on a collaborative, business aligned team. The Legal Counsel exercises sound judgment and excellent communication skills and balances risk while operating with a solutions-oriented approach. The focus of this role is to engage as a trusted business partner providing practical, timely, and context-driven legal advice to enable informed decision-making and advance enterprise objectives. Essential Accountabilities: Supports Business-Aligned Decision-Making & Serve as a Trusted Business Partner Builds strong, collaborative relationships with internal clients, legal department colleagues, and cross functional partners, grounded in trust, transparency, and shared accountability. Communicate legal advice clearly, concisely, and professionally, tailoring messages for non-legal audiences to support timely, informed decision making. Anticipates...

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Summary: The Summer College Internship Program is a 10-week paid internship experience that provides undergraduate and graduate students with the opportunity to attend development workshops, network, and be part of our company. Our college interns work on meaningful projects, are mentored under their respective managers, and continue to develop throughout the entire summer. Through the internship program, our interns can attend development workshops that are focused on key business concepts. Interns may work within the skills-based tracks of Business Administration, Information Technology, Actuarial, Human Resources, Analytics & Data, Communications, Finance, Marketing & Sales, Project Management, Clinical Studies, Customer Experience, Digital Operations, and other non-technical and/or technical based degree programs. This is a paid 10-week summer internship from the first Monday in June to the second Friday in August (up to 40 hours per week)....

Job Description: Job Description CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience. Please note that this is a hybrid position requiring both remote and on-site work. CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC....

Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation, and/or inpatient coding and has a high level of understanding of the current MS-DRG, and APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, co-morbidities, complications, secondary diagnosis, surgical procedures, POA indicators to validate coding and DRG assignment accuracy, insuring the physician documentation supports the hospital coded data. Essential Accountabilities: Level I • Analyzes and audits acute inpatient claims. Integrates medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise. Clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently....

Job Description: Summary: Data Request Support Consultant is responsible for the processes related to client data and analytic requests with a focus on alignment, appropriate communication, and ultimately completion of data and analytic requests. This position will support provider relationships, vendor relationships, and other initiatives that fall into the oversight of the reporting organization. This role collaborates with key contacts within the reporting organization while engage with clients outside the organization to ensure accurate specifications, details, and expectations related to data and analytic request. In addition, this position will engage with associated parties related to key updates and statuses related to data requests and analysis with the goal of ensuring alignment of expectations. This role serves as a subject matter expert for all data requests and analyses and will be responsible for tracking and reporting on all updates and statuses in real-time....