Req #: 2770
Job ID: 14276
Job Location: New York, NY
Zip Code: 10041
Category: Managed Care Nursing
Agency: Elderplan
Status: Regular Full-Time
Office: Remote
Salary: $92,276.31 – $115,345.38 per year
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 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
Affordable 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:
Quality Review Auditor (QRA) is responsible for ongoing audits of the care management staff, quality assurance, accuracy and overall integrity of the care management records and documentation. QRA will listen to the calls completed by the care management staff to identify gaps in knowledge and assess for professionalism of the staff completing the calls. This role is to ensure compliance with NYS DOH and CMS regulations through development of audit tools and validating all data collected. Quality Review Auditor will be responsible to analyze collected audit data, identify trends for staff re-training and implementing corrective action plans in collaboration with Coordinated Care Management staff. Provide support to Directors, Managers and Supervisors to ensure that all documentation and reporting requirements are prepared and maintained in a professional and well-coordinated manner.
Qualifications:
Graduate from an accredited School of Nursing. BSN or BS degree preferred
Minimum of two (2) years of working in care management experience required
Managed Care experience preferred
Licensed to practice as Registered Professional Nurse in NYS
Excellent analytical skills, interpretation of data
Strong critical thinking skills
Knowledge of Medicare and Medicaid regulations
Ability to set priorities and to handle multiple assignments
Working knowledge of audit techniques and methodologies
Working knowledge of State and Federal regulations
Travels to perform business partners training