Supervise a team of RNs doing concurrent review/utilization management for inpatient admissions, ensuring appropriate level of care, discharge planning coordination, and regulatory compliance. MJHS (Elderplan/HomeFirst) is a Medicare/Medicaid managed care organization focused on keeping members independent. Standout requirement/perk: target of 95%+ compliance with established criteria and guidelines.
- Medicare/Medicaid managed care focus
- Lead and develop RN staff
- Work on inpatient care appropriateness
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.
Provides quality, cost-effective care to all members through the direct supervision of staff responsible for the management and coordination of the member's care through the incorporation of interdisciplinary strategies, medicare regulations, and medically accepted standards of care. Supervises the assessment of all acute and sub-acute inpatient care for appropriateness of setting and services, according to pre-established criteria and guidelines and ensure a 95% compliance or greater. Supervises the assessment and coordination of the members physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, discharge planners. Assures appropriate staffing to support departmental/agency services. Ensures all employees are oriented to their department/agency and job and provided with appropriate training, development and continuing education. Correctly interprets and applies all Human Resources policies and procedures relative to discipline, recruitment and selection, performance appraisals, salary reviews and staffing.Bachelor's Degree in Nursing. Minimum one to three years previous management experience preferred. Previous managed care experience in the areas of utilization management and/or case management required. Working knowledge of Windows, Word, Excel. Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies.Powered by SonicJobs (an advertiser on College Recruiter). By applying, you consent to share your data with SonicJobs and the employer. College Recruiter or SonicJobs does not store or use your application data beyond facilitating the application.
See MJHS Privacy Policy at and SonicJobs Privacy Policy at us/privacy-policy and Terms of Use at us/terms-conditions