Join MJHS as an RN Coordinator to make a meaningful impact in affordable healthcare. You will address clinical appeals and grievances while ensuring compliance with regulations.
Key Responsibilities
Investigate and respond to written and/or verbal clinical appeals
Handle expedited clinical grievances and potential quality of care grievances
Ensure compliance with Elderplan Contract Benefits, CMS, and DOH regulations
Required Qualifications
Graduate of accredited nursing program
2 years managed care or hospital-based utilization/case management experience
2 years minimum clinical experience
Licensed nurse in New York State
Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook
Excellent written and verbal communication skills
Preferred Qualifications
BSN preferred
Comfortable researching current evidence-based practice guidelines and protocols
Ability to multi-task and manage multiple projects efficiently
Demonstrate analytical/critical thinking skills
Provide excellent customer service leading to positive problem resolution