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Pre-Authorization Unit Supervisor Metropolitan Jewish Health System 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
The supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions. The supervisor's daily oversight includes reviewing data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability), provides direction for complex cases, monitors pending cases, reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.
Graduate of an accredited nursing program: baccalaureate degree preferred. Minimum one to three years' previous management experience preferred. Previous managed care experience in the areas of utilization management and/or case management preferred. Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health. Licensed to practice as a Registured Nurse in the state of New York with current registration. CCM preferred Knowledge of InterQual preferred. Knowledge of Federal and State regulatory requirements for managed care. Posted 4 hours ago FRFS Change and Release Coordinator. Federal Reserve Bank of Kansas City The FRFS Change and Release Coordinator performs a critical role leading all aspects of the release and change lifecycle within FRFS. This position will be focused primarily on the Retail Payments applications, including FedACH and Check Services. The individual will be responsible for all aspects of the change control process including ticketing, executing installs into controlled environments, and managing key release milestones across multiple delivery teams. The FRFS Change and Release Coordinator is expected to demonstrate working knowledge of the CI/CD tools, source code management, and software development lifecycles. While this role does not involve management of direct reports, it does require strong facilitation and collaboration with cross-functional teams to ensure successful delivery of key business capabilities to support Federal Reserve Financial Services. Posted 4 hours ago Patient Safety Sitter - Emergency Room - Old Bridge - Per Diem Nights. Hackensack Meridian Health Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. Posted 4 hours ago FT Lead Certified Receiver - 6095. The GIANT Company At The GIANT Company, we are passionate about building strong families and healthy communities, serving millions of neighbors across Pennsylvania, Maryland, Virginia, West Virginia, and New Jersey. We are committed to being an inclusive place to work and shop. Our shared values of care, courage, integrity, teamwork, and humor guide our work as we embrace the unique talents and differences of every team member. We also take pride in connecting families for a better future. If you're ready for a purposeful career, join our GIANT family. You'll help us make a difference while making some great connections and friendships along the way. Posted 5 hours ago Supervisor Transmission & Distribution. Veolia North America A subsidiary of Veolia Group, Veolia North America (VNA) offers a full spectrum of water, waste and energy management services, including water, and wastewater treatment, commercial and hazardous waste collection and disposal, energy consulting and resource recovery. VNA helps commercial, industrial, healthcare, higher education, and municipality customers throughout North America. Headquartered in Boston, Mass., Veolia North America has approximately 10,000 employees working at more than 350 locations across the continent. Please visit our Posted 5 hours ago Summer Intern (Laborer) Veolia North America A subsidiary of Veolia Group, Veolia North America (VNA) offers a full spectrum of water, waste and energy management services, including water, and wastewater treatment, commercial and hazardous waste collection and disposal, energy consulting and resource recovery. VNA helps commercial, industrial, healthcare, higher education, and municipality customers throughout North America. Headquartered in Boston, Mass., Veolia North America has approximately 10,000 employees working at more than 350 locations across the continent. Please visit our Posted 5 hours ago Shipping & Receiving. Veolia Water Technologies and Solutions Veolia Water Technologies & Solutions (VWTS) is a worldwide leader in water recovery, treatment, and reuse. We design, supply, and service a range of water systems and monitoring equipment in industries ranging from pharmaceutical to food and beverage applications, and from microelectronics ultrapure water to municipal water and industrial wastewater treatment. We are one of the world's leading manufacturers of total organic carbon (TOC) analyzers and corresponding certified reference materials. Our ground-breaking endotoxin analyzer is the latest addition to our expanding analytical instruments portfolio. We strive to provide not only superior technology and design, but also outstanding quality, service, and application support. Posted 5 hours ago Shipping & Receiving. Veolia North America Veolia Water Technologies & Solutions (VWTS) is a worldwide leader in water recovery, treatment, and reuse. We design, supply, and service a range of water systems and monitoring equipment in industries ranging from pharmaceutical to food and beverage applications, and from microelectronics ultrapure water to municipal water and industrial wastewater treatment. We are one of the world's leading manufacturers of total organic carbon (TOC) analyzers and corresponding certified reference materials. Our ground-breaking endotoxin analyzer is the latest addition to our expanding analytical instruments portfolio. We strive to provide not only superior technology and design, but also outstanding quality, service, and application support. Posted 5 hours ago Environmental Specialist I Depack. Veolia North America A subsidiary of Veolia Group, Veolia North America (VNA) offers a full spectrum of water, waste and energy management services, including water, and wastewater treatment, commercial and hazardous waste collection and disposal, energy consulting and resource recovery. VNA helps commercial, industrial, healthcare, higher education, and municipality customers throughout North America. Headquartered in Boston, Mass., Veolia North America has approximately 10,000 employees working at more than 350 locations across the continent. Please visit our Posted 6 hours ago General Warehouse CDC Wire - 2nd shift. U.S. Electrical Services, Inc. USESI has an immediate opening for Warehouse Worker- 2nd shift within our Cranbury, NJ distribution center. We are looking for safety, quality, growth-minded, dedicated, adaptable, and team-oriented individuals to join our team. Posted 6 hours ago Description
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
The supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions. The supervisor's daily oversight includes reviewing data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability), provides direction for complex cases, monitors pending cases, reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.
Graduate of an accredited nursing program: baccalaureate degree preferred. Minimum one to three years' previous management experience preferred. Previous managed care experience in the areas of utilization management and/or case management preferred. Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health. Licensed to practice as a Registured Nurse in the state of New York with current registration. CCM preferred Knowledge of InterQual preferred. Knowledge of Federal and State regulatory requirements for managed care. View more.. 
