Responsibilities
The supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions.The supervisor’s daily oversight includes reviewing data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability), provides direction for complex cases, monitors pending cases, reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.
Qualifications
- Graduate of an accredited nursing program: baccalaureate degree preferred.
- Minimum one to three years' previous management experience preferred.
- Previous managed care experience in the areas of utilization management and/or case management preferred.
- Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health.
- Licensed to practice as a Registured Nurse in the state of New York with current registration.
- CCM preferred
- Knowledge of InterQual preferred.
- Knowledge of Federal and State regulatory requirements for managed care.
MinUSD $101,503.41/Yr.
MaxUSD $126,879.27/Yr.
