RN Appeals Coordinator — Managed Care & Quality Outcomes

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

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.