About this opportunity
MJHS lists this Pre-Authorization Unit Supervisor opportunity in new york, New York. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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.QualificationsGraduate 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.
Worksite address
new york, NY, 10004, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.