A&G RN Coordinator | Fee-for-Service

Metropolitan Jewish Health System; New York (NY); On-site; USD 85,000 - 100,000; Full time

Benefits offered by this job

Sign-on bonuses

Tuition reimbursement

Retirement plans

Job summary

Metropolitan Jewish Health System in New York seeks an RN Coordinator to review and resolve clinical appeals and grievances within Elderplan and HomeFirst, ensuring CMS and DOH compliance. The role involves coordinating with members and providers to improve quality of care.

The ideal candidate is a NY-licensed RN with 2+ years in managed care or hospital utilization, 2+ years clinical experience, BSN preferred, and solid MS Office skills.

Qualifications

• Graduate of accredited nursing program; BSN preferred.
• 2 years managed care or hospital utilization/case management experience.
• 2 years minimum clinical experience.
• Licensed nurse in New York State.
• Proficiency with Microsoft Word, Excel, PowerPoint and Outlook.
• Excellent written and verbal communication skills.
• Must be able to multi-task and manage multiple projects efficiently.
• Analytical/critical thinking and provided customer service lead to positive resolutions.

Responsibilities

• Investigate and respond to written and/or verbal clinical appeals and expedited grievances.
• Ensure compliance with CMS and DOH regulations in processes.
• Collaborate with members and providers to address quality of care concerns.

Skills

Communication skills

Verbal communication

Written communication

Analytical thinking

Customer service

Multitasking

Education

RN license NY

BSN preferred

Tools

MS Word

MS Excel

MS 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
• ++FREE++Online RN to BSN and MSN degree programs!
• ++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 ulilization/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 ad verbal communication skills
• Must be comfortable researching current evidence based practice guidelines and protocols
• Must be able to multi-task and managed multiple projects efficiently, meet deadlines, demonstrate analytical/critical thinking skills, and provide excellent customer services that leads to positive problem resolution

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