Join MJHS as an RN Coordinator, where you'll play a vital role in addressing clinical appeals and grievances, ensuring high-quality healthcare for our members. Your expertise will help maintain compliance with healthcare regulations and improve patient outcomes.
Key Responsibilities
Investigate and respond to clinical appeals and grievances
Ensure compliance with Elderplan Contract Benefits, CMS, and DOH regulations
Required Qualifications
Graduate of accredited nursing program
Licensed nurse in New York State
2 years managed care or hospital-based utilization/case management experience
2 years minimum clinical experience
Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook
Excellent written and verbal communication skills
Ability to research current evidence-based practice guidelines and protocols
Ability to multi-task and manage multiple projects efficiently