CDPHP

Job Description: Summary: This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, to meet departmental time frames. Per department needs, may be responsible for additional hours. Essential Accountabilities: Level I Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of services requested for the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical review...

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: 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 is responsible for delivering multiple concurrent, and sometimes accelerated, Pharmacy Innovation projects and programs with quality, to plan, and budget, and in support of department strategy. In addition, conducts operational process analysis, process improvement identification, program refinement and recommendations, and executes action plans. The incumbent, working in partnership with internal and external partners, is responsible for all aspects of the project from initiation to post-implementation monitoring and maintenance. This role includes supporting ideation, solutioning, resourcing, program delivery, monitoring, and stakeholder communication . Essential Accountabilities: Level I Plans, directs, and coordinates matrixed team(s) activities to manage and implement assigned and interrelated Pharmacy Innovation projects and programs through the innovation cycles of ideation, assessment, delivery, and refinement. Following the launch...

Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member's needs, health goals and mitigate health care cost drivers. Essential...

Job Description: Summary: Under general supervision of department management, the Production Print Specialist may support one or more areas of Production Operations. Assignments are determined based on need; shifts may include day, evening and/or overnight hours, with some including weekend coverage. NOTE: Incumbent will be notified 3 days ahead of any shift assignment adjustment. Essential Accountabilities: All Levels Specific work activities are assigned daily based on work volumes and department needs. Observes safety and housekeeping standards in work area. Maintains appropriate files, records, and equipment manuals. Informs supervisor of equipment issues. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and...

Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment. Essential Accountabilities: Level I Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment. Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies. Perform triage for UM Services. Serves as the primary contact for providers regarding authorization requests. Contacts members and providers concerning...

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: 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 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: This role provides the vision, strategy, functionality, and technology solutions for creating and maintaining network platforms for both public and private cloud infrastructure-based solutions. This entails the design and use of flexible platforms that deliver features, functionality, and services compatible with industry-leading providers while allowing legacy systems to interact safely when required. This position requires the necessary skills to provide technology research, evaluation, development, and delivery in support of infrastructure deployment solution lifecycles. The candidate will work directly with the Information Technology teams to lead the organization toward the deployment of technologies that may include PaaS, SaaS, hosted, and on-premises subscriptions - which will allow for flexible, secure, on-demand cloud-like functionality and services while endeavoring to provide resiliency and achieve cost reduction, while maintaining a...

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: 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 Information Security Architect assists in the development and execution of the information security risk management strategy, risk assessment philosophy and the IT components of Lifetime Healthcare Companies' Enterprise Risk Management program. This position participates in IT security investment analysis, design, scope and approach. The primary responsibility is to provide technical expertise for the Information Security Group and serve as a trusted security advisor to the business and divisional initiatives. The architect helps to ensure a secure, risk based, and cost-effective infrastructure and application design is developed and maintained. This position advises and consults with Information Security management, and various levels of business and IT leadership, regarding the protection of corporate information and the direction of the Information Security Program. Essential Accountabilities: Level I •\tParticipates in development and...