Graduate of an accredited nursing program; baccalaureate degree preferred.
1-3 years of management experience preferred.
Managed care experience in utilization management or case management preferred.
1 year of nursing practice in clinical settings (hospital, nursing facility, home health).
Licensed as a Registered Nurse in New York with current registration.
Certified Case Manager (CCM) preferred.
Familiarity with InterQual and regulatory requirements for managed care.
Responsibilities
Oversee day-to-day operations of MLTC/DSNP pre-authorization functions.
Review data to ensure compliance with regulatory requirements.
Direct oversight for complex case management.
Monitor and manage pending cases effectively.
Educate staff on current criteria trends and updates.
Facilitate communication between departments.
Benefits
Hybrid work schedule.
Opportunities for professional development and growth.
Health insurance options.
Retirement savings plan with employer contribution.
Full Job Description
Req #: 4348 Job ID: 15756 Job Location: New York, NY Zip Code: 10041 Category: Management - Clinical Agency: Elderplan Status: Regular Full-Time Office: Hybrid
Salary: $101,503.41 - $126,879.27 per year
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 Registered 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.
About Metropolitan Jewish Health System
Metropolitan Jewish Health System is a non-profit organization that provides health care services to seniors and individuals with chronic illnesses in the New York City area. The organization was founded in 1907 and has since grown to become one of the largest providers of home health care, hospice care, and long-term care in the region. Metropolitan Jewish Health System's services include skilled nursing, rehabilitation, palliative care, and social work. The organization is committed to providing high-quality, compassionate care to its patients and their families. Metropolitan Jewish Health System is headquartered in Brooklyn, New York.
