Leading MLTC offering a remote work environment!
Job Detail
Job Description
Responsibilities:
- Process all requests for services in accordance with Medicare and NYS Medicaid guidelines as well as departmental criteria and guidelines.
- Work collaboratively with other disciplines including care manager, assessment nurse and primary care physician or other specialists as necessary to ensure timely provision of services.
- Coordinate timely completion of UAS NY assessment that accurately reflects the current condition of the member.
- Ensure that the members individualized person centered care plan has been updated and accurately reflects present status of the member
Qualifications:
- BGD: RN, Bach preferred
- Knowledge of UM process, 3-5 years of nursing exp
- Prior exp in managed care w knowledge of Medicare and Medicaid
- strong assessment skills – knowledge of InterQual
- Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
- Prior experience in an interdisciplinary service delivery environment preferred
- Working knowledge of Medicare and Medicaid regulations
- Prior experience in an interdisciplinary service delivery environment preferred
- Working knowledge of Windows, Word and Excel
- Knowledge of current standards of medical practice and healthcare delivery systems
- Strong assessment skills
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