Registered Nurse - 239038 Job at Medix™, New York, NY

SUswcFZka1dLM2lpR2dPTXRpV3Z6TVVXNWc9PQ==
  • Medix™
  • New York, NY

Job Description

Job Title: Disenrollment Coordinator (must be LMSW/LCSW or RN)

***Must be bilingual/fluent in Spanish***

Location: Remote (must be licensed in NY and sit in NY, NJ or CT)

Pay:

RN Pay: $49-52

SW Pay: $34-40

Hours: M-F, day shift (40 hours)

  • Must have an LMSW/ LCSW or RN licensed in New York
  • Contract to Hire
  • Spanish speaking required.
  • Must be a NY licensed individual and sit in NY, NJ, and CT.
  • Must have health plan, MLTC and care management experience
  • Interviews include one screen with HR and 1 with the clinical team
  • Need to be computer savvy with strong Excel skills.
  • The job is to disenroll patients while also keeping them in the plan. For example, when someone doesn't meet one plan they need to disenroll them but also try to bring them on under other product lines and service areas.
  • It is very task based/not project based, so they need someone who can work independently and be able to think critically.

Overview:

  • Applies clinical and critical thinking skills in evaluating the content of disenrollment requests.
  • Communicate with the clinical teams regarding safety concerns and regulatory requirements on an ongoing basis.
  • Validate content of disenrollment requests in reviewing of Uniform Assessment System UAS assessments, care plans, medical authorizations, and supporting documentation ensure compliance with regulatory requirements and internal policy.
  • Ensure disenrollments are processed within 24 hour time frame.
  • Communicate with internal teams and external facilities and vendors for safe and successful processing of disenrollments from the plan.
  • Maintains tracking tool to log disenrollment review results including areas of noncompliance and informing PCMs in what areas of improvement are needed for discussion with their managers as it pertains to disenrollment.
  • Address authorizations to reflect exit date from plan.
  • Outreach and communicate with members and representatives as needed in reference to disenrollment status requests Additional duties as assigned.

Job Tags

Contract work, Remote job, Day shift,

Similar Jobs

Cushman & Wakefield

Scaffold Insulation Technician Job at Cushman & Wakefield

 ...Job Title Scaffold Insulation Technician Job Description Summary Job Description Who Are We? C&W Services is the industry...  ...all company / site safety guidelines and procedures. ~ Installation, Maintenance, and Repair to be performed in conformance with... 

Grace Management, Inc.

Wellness Director - Senior Living Job at Grace Management, Inc.

 ...Inspire Wellness and Connection in Chicago! Grace Management, Inc. is seeking an energetic and compassionate Wellness Director to support the vibrant senior living community of The Hallmark . In this key leadership role, youll champion residents physical, emotional... 

Friedman's Home Improvement

Assistant Store Manager Job at Friedman's Home Improvement

 ...Improvement retail store in Petaluma. Hours are to meet the needs of the retail business, Sunday Saturday. Ability to work holidays and weekends. Friedmans Home Improvement is proud to be an Equal Opportunity Employer, committed to a diverse and inclusive work... 

Texlahoma BBQ

Meat Cutter - East Edmond Location Job at Texlahoma BBQ

 ...Meat Cutter - Texlahoma East 2nd Street Meat Cutter - Texlahoma BBQ. Location - East Edmond. Pay Rate - $12.00 - 16.00 Per Hour. Job Details: Meat cutters slice brisket, turkey, sausage, ribs, bologna, and pull pork for orders. Previous experience in... 

Kevin Edward

Mechanical, Electrical, and Plumbing Engineer Job at Kevin Edward

 ...MEP Procurement Engineer Procurement & Supply Chain (Hybrid) A leading national general contractor is confidentially seeking a MEP Procurement Engineer to support complex commercial and industrial construction projects across the U.S. This role blends technical MEP...