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:
Sign-on Bonuses OR Student Loan Assistance for clinical staffFREE Online RN to BSN and MSN degree programs!Tuition Reimbursement for all full and part-time staffDependent Tuition Reimbursement for clinical staff!Generous paid time offAffordable medical, dental and vision coverage for employee and family membersTwo retirement plans! 403(b) AND Employer Paid PensionFlexible spendingAnd MORE!
MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)
ResponsibilitiesResponsible for direct oversight and management of clinical review processes within Appeals & Grievances Department. Ensures regulatory compliance and timely processing for the Medicare and Medicaid appeal and grievance processes, quality of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service or clinical quality. Acts as subject matter expert to internal departments and delegated vendors to assure all are educated and complaint with requirements of appeals and grievance regulations and processing
Qualifications Bachelor’s Degree required. Master’s preferred5 plus years’ experience in managed care including appeals and grievance and/or compliance2 years’ prior supervisory or management experience requiredStrong knowledge of federal, state and managed healthcare regulations and requirementsNYS RN License Degree. Strong leadership skillsDetail oriented. Excellent computer software skills including Microsoft Office, Access, PowerPoint, MS Project Min USD $115,104.83/Yr. Max USD $143,881.04/Yr. Options Apply for this job onlineApplyShareRefer this job to a friendRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Share on your newsfeed Need help finding the right job? We can recommend jobs specifically for you! Click here to get started. Application FAQsSoftware Powered by iCIMS
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