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About the Role
Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are expanding services to meet patient and member needs, helping people live independently. MJHS is a supportive community committed to excellence, respect, and high-quality, personalized healthcare services.
Responsibilities
- Process requests for selected elective services, out-of-network requests, out-of-area requests, and durable medical equipment in accordance with departmental criteria, regulatory standards, and Medicare guidelines.
- Communicate all elective hospital admissions to the appropriate Utilization Management Coordinator and/or Care Manager to ensure timely receipt of information and continuity of member care.
- Ensure authorizations are appropriate, and determinations are made and documented to facilitate claims processing, data record integrity, and to minimize unnecessary retrospective review.
- Apply program criteria to identify members for Care Management and Geriatric Case Management during the pre-authorization, concurrent review, and discharge planning process.
Requirements
- Graduate of an accredited Practical Nursing Program.
- Current LPN NY license and registration required.
- Minimum of 1-3 years Medical/Surgical nursing experience.
- Prior managed care experience preferred.
- Familiarity with Utilization management processes preferred.
- Working knowledge of Windows, Word, and Excel.
- Knowledge of current standards of medical practice and healthcare delivery systems.
- Excellent written and oral communication skills.
- Good analytical abilities.
Skills
- Windows
- Word
- Excel
- Medical/Surgical nursing
- Managed care
- Utilization management
- Medical practice standards
- Healthcare delivery systems
- Written communication
- Oral communication
- Analytical abilities
Experience Level
- 1-3 years
Education Level
- LPN
Salary/Compensations
- USD $60,673.04/Yr. - USD $75,841.30/Yr.
Benefits
- Sign-on Bonuses OR Student Loan Assistance for clinical staff
- Tuition Reimbursement for all full and part-time 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
- Qualified employer under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)
About the Company
- MJHS is more than a workplace; it is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
- MJHS fosters collaboration, celebrates achievements, and promotes fairness for all.
- MJHS offers comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within the organization, and the fulfillment of having a lasting impact on the communities served.