Pre-Authorization Unit Supervisor / RN / Hybrid / Manhattan NY based high-quality Medicare and Medicaid health plans designed to help keep people independent and living life on their own terms. Hybrid role - Combinations office based in Downtown, Manhattan and Work from Home.
Salary: $102,000 to - $125,000 ( Depending on Experience )
Hybrid work schedule. 2 days per week in Manhattan office, 3 days are work from home.
Summary:
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.
Benefits include:
Tuition Reimbursement for all full and part-time staff
Generous paid time off
Affordable medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Flexible spending
And MORE!
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