Pre-Authorization Unit Supervisor
mjhsNew York, NY
$101,503.41/YrAPPLY NOW
Pre-Authorization Unit Supervisor
mjhsNew York, NY
10 days ago
Industries
Services for the Elderly and Persons with DisabilitiesNursing Care Facilities (Skilled Nursing Facilities)HMO Medical Centers$101,503.41/Yr
APPLY NOWAbout the role
Job TitleThe supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions. The supervisor's daily oversight includes reviewing data to monitor regulatory requirements (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 new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.
Qualifications:
Graduate of an accredited nursing program: baccalaureate degree preferred.
Minimum one to three years' previous management experience preferred.
Previous managed care experience in the areas of utilization management and/or case management preferred.
Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health.
Licensed to practice as a Registered Nurse in the state of New York with current registration.
CCM preferred.
Knowledge of InterQual preferred.
Knowledge of Federal and State regulatory requirements for managed care.
Salary RangeMin USD $101,503.41/Yr.
Max USD $126,879.27/Yr.
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JOB OVERVIEW
Salary
$101,503.41/Yr
Experience level
Manager
Location
New York, NY
Occupation
Registered Nurses
Industry
Services for the Elderly and Persons with Disabilities
Posted
10 days ago
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