PRE-AUTHORIZATION UNIT SUPERVISOR

Company: MJHS
Location: New York
Posted on: October 25, 2024

Job Description:

Req #:
1942

Job ID:
13490

Job Location:
New York, NY

Zip Code:
10041

Category:
Management - Clinical

Agency:
Elderplan

Status:
Regular Full-Time

Office:
Hybrid

Salary:
$101,503.41 - $126,879.27 per year

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans ! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE! MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF)
  
  Responsibilities:
  
  The supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions.The supervisor's daily oversight includes reviewing data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability), provides direction for complex cases, monitors pending cases, reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.
  
  Qualifications:
  • Graduate of an accredited nursing program: baccalaureate degree preferred.
  • Minimum one to three years' previous management experience preferred.
  • Previous managed care experience in the areas of utilization management and/or case management preferred.
  • Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health.
  • Licensed to practice as a Registured Nurse in the state of New York with current registration.
  • CCM preferred
  • Knowledge of InterQual preferred.
  • Knowledge of Federal and State regulatory requirements for managed care.

Keywords: MJHS, Danbury , PRE-AUTHORIZATION UNIT SUPERVISOR, Other , New York, Connecticut