Req #: 4336
Job ID: 15743
Job Location: New York, NY
Zip Code: 10041
Category: Managed Care Nursing
Agency: Elderplan
Status: Regular Full-Time
Office: Office-based
Salary: $110,000.00 - $120,000.00 per year
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
