A&G RN Coordinator
$110,000–$110,000 year
On-siteNew York City, New York, United States or New York, United States
New York City, New York, United States or New York, United StatesOn-siteFull Time$110,000–$110,000 yearLicense Or CertificationLarge
Full TimeLicense Or CertificationLarge
Job Summary
Investigate and respond to written and/or verbal clinical appeals, expedited clinical grievances, and potential quality of care grievances submitted by members and providers. Execute this work in accordance with Elderplan Contract Benefits, CMS, and DOH regulations. Research current evidence-based practice guidelines and protocols to support problem resolution. Requires a licensed New York State nurse with at least two years of managed care or hospital-based utilization/case management experience. Salary ranges from $110,000 to $120,000 annually.
Required Qualifications
- Graduate of accredited nursing program
- 2 years managed care or hospital based utilization/case management experience
- 2 years minimum clinical experience
- Licensed nurse in New York State
- Proficiency with Microsoft Word, Excel, Power Point and Outlook
- Excellent written and verbal communication skills
- Comfortable researching current evidence based practice guidelines and protocols
- Ability to multi-task and manage multiple projects efficiently
- Meeting deadlines
- Demonstrating analytical and critical thinking skills
- Providing excellent customer service that leads to positive problem resolution
Desired Qualifications
- BSN
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