PRE-AUTHORIZATION SUPERVISOR

Company: Tandym Group
Location: New York
Posted on: November 20, 2024

Job Description:

A managed long term care plan (MLTC) in Manhattan is currently seeking a registered nurse (RN) to lead a case management team as a Pre-Authorization Supervisor.

About the opportunity:

Hours: Monday through Friday, business hours
Setting: Managed Care
Work model: Hybrid setting - 2 days a week in office after training.


Responsibilities:

The Pre-Authorization Supervisor will be responsible for:

* Oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions
* Reviewing data to monitor regulatory requirements
* Providing direction for complex cases, monitoring pending cases, and monitoring regulatory requirements.
* Reviewing and educating staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations
* Other duties, as needed

Qualifications:
* NYS licensed Registered Nurse (RN)
* Previous managed care experience in the area of utilization review and case management
* Minimum 1 year of supervisory experience

Desired Skills:
* BSN preferred
* InterQual experience preferred
* CCM

Keywords: Tandym Group, Brentwood , PRE-AUTHORIZATION SUPERVISOR, Other , New York, New York