RN Appeals & Care Quality Coordinator

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

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.