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Job Description
Join MJHS as an RN Coordinator, where you'll play a vital role in ensuring quality care for our members by managing clinical appeals and grievances. Leverage your nursing expertise to make a meaningful impact in affordable healthcare.
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, Power Point, and Outlook
Excellent written and verbal communication skills
Ability to research current evidence-based practice guidelines and protocols
Strong multi-tasking and project management skills