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

Planet Pharma

Scientist II Job at Planet Pharma

 ...in the labs Formulation experience Experience with pharma or consumer product development Strong technical writing and communication skills. Must be proficient using Word, Excel, and statistical software. Knowledge of fundamental application of statistics is preferred... 

Highway

Application Operations Assistant Manager Job at Highway

About the Company: Highway is the fastest-growing freight tech provider in North America. We serve the largest freight brokers in the industry, solving one of their biggest pain points: who is really hauling their freight. We answer the question of Carrier Identity, protecting...

The LiRo Group

Senior Electrical Engineer Job at The LiRo Group

 ...Responsibilities ~ Lead the design and development of electrical systems including power distribution, lighting, fire alarm and low voltage systems for commercial, industrial, municipal and healthcare facilities. ~ Perform load calculations, equipment sizing using... 

Coastal Wave Recruiting

Litigation Attorney - Associate Job at Coastal Wave Recruiting

 ...responsibility, and contribute to the growth and success of the practice. Position Summary We are seeking a talented Litigation Attorney (Associate level) with 3+ years of experience in civil litigation to join our team. The ideal candidate will be proficient in all... 

Elevator Services Group

Resident Elevator Mechanic Job at Elevator Services Group

 ...Position: Resident Elevator Mechanic Job Summary: The Resident Elevator Mechanic is responsible for the maintenance, repair, troubleshooting, and modernization of elevator systems within an assigned property or portfolio of buildings. This position ensures safe,...