Pre-Authorization Unit Supervisor

MJHS • New York, NY

7d

About The Position

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Requirements

• 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.
• Knowledge of Federal and State regulatory requirements for managed care.

Nice To Haves

• CCM preferred
• Knowledge of InterQual preferred.

Responsibilities

• Oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions.
• 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).
• Acts as a liaison with interdepartmental communication.

Benefits

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• Free MSN in Education program!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans ! 403(b) AND Employer Paid Pension
• Flexible spending
• MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree