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

Addison Group

Insurance Follow-Up Representative Job at Addison Group

 ...Job Title: Insurance Follow-Up Representative Industry: Healthcare Location: Columbia, SC Pay: $17-$21 / hour Benefits:...  ...vision, and 401(k). About Our Client: Addison Group is working with a growing healthcare organization to find an Insurance Follow... 

Lyneer Search Group

Corporate Secretary & Assistant General Counsel Job at Lyneer Search Group

 ...operations, corporate recordkeeping, disclosure obligations, and shareholder communications. This position is well-suited for a senior legal professional with deep expertise in public company reporting (10-K, 10-Q, 8-K) , insider trading compliance, governance best... 

REMAX

Marketing Coordinator Job at REMAX

 ...required distribution space. Create net-new collateral and content as required to support U.S. and Canada broker/owners, agents, franchise sales team, customer success and recruiting/retention efforts. Support sponsorships and events alongside the Communications... 

United Airlines

Engineer - Flight Operations Engineering and Analysis (Remote) Job at United Airlines

 ...next with us. Let's define tomorrow together. Get ready for a career at the leading edge of the airline industry! Our Flight Operations Engineering team works hard to connect people and unite the world safely, reliably and efficiently every single day. From industry... 

C-SUITE ASSISTANTS

Personal Assistant Job at C-SUITE ASSISTANTS

 ...including detailed itineraries, personal and professional Work closely and liaise with key team executives to support on-going...  ...anything you do ~ Very organized and detail-oriented ~ Google Suite, Tech Savvy, Slack ~ An interest or gaming experience...