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    Supervisor of Pre-Certification Support - New York, United States - MJHS

    MJHS
    MJHS New York, United States

    3 weeks ago

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    Description
    Req #:
    1649

    Job ID:
    13205

    Job Location:
    New York, NY

    Zip Code:
    10040

    Category:
    Management - Non-Clinical

    Agency:
    Elderplan

    Status:
    Regular Full-Time

    Office:
    Hybrid

    Salary:
    $61, $73,755.75 per year

    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.

    Why work for MJHS?:

    When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents, and health plan members, and we will take care of the rest

    Benefits include:
    • Tuition Reimbursement for all full and part-time staff
    • Generous paid time off
    • Affordable 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:

    Oversees all aspects of the Precertification Support services regarding MAPD precertification requirements. The supervisor oversees and ensures compliance with CMS regulations and departmental policies including regulatory timeframes (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 criteria changes (including InterQual, Local Coverage Determinations (LCD), National Coverage Determinations NCD); and acts as a liaison with other departments.

    Works closely with Supervisors of Case Management and Pre-Certification on all initiatives and unit functions.

    Qualifications:
    • Graduate of a health care associate degree program. Bachelor's degree in business, human services, or a health-related field preferred.
    • Minimum 3 years of Managed care experience in the areas of utilization management and/or case management required.
    • Proficiency in Microsoft Word, Excel, and Windows operating systems.
    • Excellent customer service, oral communication, writing, and typing skills. Excellent telephone assessment skills.
    • Working knowledge of utilization management processes Knowledge of Federal and State regulations and managed care regulations and concepts.
    • Ability to provide appropriate support and direction to facilitate collaborative efforts toward accomplishing Department goals and objectives.
    • Demonstrates knowledge/ability of Institutional goals and changing trends in healthcare and cost factors in delivering patient care.
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