Why work for MJHS?

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors.

Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.

You take care of our patients, residents and health plan members, and we will take care of the rest!

Benefits include :

• Tuition Reimbursementfor all full and part-time staff
• Generous paid time off
• Affordablemedical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities :

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.

Qualifications :

• 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.
• CCM preferred
• Knowledge of InterQual preferred.
• Knowledge of Federal and State regulatory requirements for managed care.

Last updated : 2024-05-30