A&G RN Coordinator

Metropolitan Jewish Health System; New York (NY); On-site; USD 110,000 - 120,000; Full time

Benefits offered by this job

Sign-on Bonus

Student Loan Assistance

Tuition Reimbursement

Dependent Tuition Reimbursement

Paid time off including birthday

Medical, Dental and Vision coverage

Two retirement plans

Flexible spending

PSLF

Job summary

Metropolitan Jewish Health System seeks an experienced RN Coordinator to investigate and respond to clinical appeals, expedited grievances, and quality of care concerns from members and providers, in line with Elderplan benefits, CMS rules, and DOH regulations.

The ideal candidate is a New York state licensed nurse with 2+ years in managed care or hospital utilization/case management, strong communication skills, and the ability to multi-task and meet deadlines in a collaborative environment.

Qualifications

• Graduate of accredited nursing program; BSN preferred.
• 2 years managed care or hospital-based utilization/case management experience.
• 2 years minimum clinical experience.
• Licensed nurse in New York State.
• Proficiency with Microsoft Word, Excel, PowerPoint and Outlook is required.
• Excellent written and verbal communication skills are essential.
• Comfortable researching current evidence-based practice guidelines and protocols.
• Able to multi-task, manage multiple projects, meet deadlines, and provide excellent customer service.

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 and DOH regulations.

Skills

Communication skills

Multitasking / analytical thinking

Customer service orientation

Research evidence-based guidelines

Education

BSN preferred

Graduate of accredited nursing program

Licensed nurse in New York State

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Overview

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.

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• MSN in Education offered!
• 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
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

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 utilization/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 and verbal communication skills
• Must be comfortable researching current evidence based practice guidelines and protocols
• Must be able to multi-task and manage multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that lead to positive problem resolution

Min

USD $110,000.00/Yr.

Max

USD $120,000.00/Yr.