Join MJHS as an RN Coordinator to lead the charge in addressing clinical appeals and grievances, ensuring high-quality healthcare services for our members. Your expertise will directly impact patient care and satisfaction.
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
Ability to research current evidence-based practice guidelines and protocols
Ability to multi-task and manage multiple projects efficiently