Pre-Authorization Unit Supervisor
MJHS · New York, NY · Today
ManagementFull-time
About the role
The supervisor will oversee the day-to-day functioning of the MLTC/DSNP pre-authorization functions.
Responsibilities
- Review data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability)
- Provides direction for complex cases
- Makes sure pending cases are monitored
- Reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations)
- Acts as a liaison with interdepartmental communication
Requirements
- Graduate 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 Registured 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