Responsibilities
The RN Coordinator will investigate and respond to written and/or verbal clinical appeals, expedited clinical grievances and potential quality of care grievances submitted by members and providers in accordance with Elderplan Contract Benefits, CMS (Centers for Medicare & Medicaid Services), and DOH (Department of Health) regulations.
Qualifications
- Graduate of accredited nursing program; BSN preferred
- 2 years managed care or hospital based ulilization/case management experience
- 2 years minimum clinical experience
- Licensed nurse in New York State
- Proficiency with Microsoft Word, Excel, Power Point and Outlook is required
- Must have excellent written ad verbal communication skills
- Must be comfortable researching current evidence based practice guidelines and protocols
- Must be able to multi-task and managed multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that leads to positive problem resolution
MinUSD $110,000.00/Yr.
MaxUSD $120,000.00/Yr.
