Overview

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. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives. The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve. Benefits include: Sign-on Bonuses OR Student Loan Assistance for clinical staff FREE Online RN to BSN and MSN degree programs! Tuition Reimbursement for all full and part-time staff Dependent Tuition Reimbursement for clinical 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 And MORE! MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

The position requires the registered nurse to perform case reviews and process all requests for elective services and durable medical equipment in accordance with the Center for Medicare and Medicaid Guidelines, New York State Medicaid Guidelines, evidence-based Best Practice Guidelines, as well as other departmental criteria and protocols. Works collaboratively with other disciplines within and outside of the department including Physician Advisors, Vendors, Providers, Member’s Primary Care Physicians, and other Specialists as necessary to ensure compliance with regulatory standards and timely provision of services. The registered Nurse will provide high-quality customer service.

Qualifications

Graduate of an accredited Nursing Program. Bachelors preferred. Current New York State RN License required. A minimum of two years of clinical experience is preferred; relevant managed care healthcare experience may be considered in lieu of clinical nursing experience. Knowledge of Utilization management processes is required. Prior managed care experience is required. Working knowledge of Medicare and Medicaid regulations is required. Knowledge of current standards of medical practice and healthcare delivery systems. Working knowledge of Windows, Word, and Excel. Excellent written and oral communication skills. Ability to manage multiple priorities, effective organizational, and time management skills. Good analytic abilities. Min USD $90,000.00/Yr. Max USD $110,000.00/Yr.