Job description
- Full-time
- (Hybrid)
Position Overview:
- The ideal candidate will be responsible for monitoring, submitting, and obtaining Managed Care Organization (MCO) authorization for all consumers with an MCO provider for Easterseals’ Programs.
- You will also ensure that authorization has been done accurately and submitted in a timely manner, including successfully obtaining initial and concurrent authorization of MCOs for services rendered.
- Communicate and follow up with MCO’s regarding discrepancies.
- Attend organizational in-service training and staff meetings and any other agency-related activities as required.
- Design a functional and efficient program to prepare for MCO-based payment.
- Perform the ongoing evaluation of the program and system, staff, and organization’s needs.
- Monitor the efficiency and efficacy of Prior Authorization.
- Navigate the Electronic Health Record to find data and support level of care recommendations.
- Collaborate with internal billing department as needed.
- Maintain compliance with federal, state, and local rules and regulations.
- Collaborate/communicate with internal and external stakeholders involved in clients' care.
- Must have a current New Jersey license in the field of Social Work.
- In lieu of licensed Social Work will accept New Jersey RN, LPN (baccalaureate level preferably) or experience in utilization review or case management.
- Must have two (2) years of experience in the field of psychiatry.
- Understand Medicare/Medicaid eligibility rules and Managed Long Term Services and Supports (MLTSS) criteria.
- Working knowledge of the Case Management Society of America's Standards of Practice.
- Demonstrated knowledge of health insurance, funding sources, applicable laws and regulations, and health information technology relevant to case management and the utilization review process.
- Knowledgeable of the chronic persistent mentally ill population (CPMI) to support and assist in planning and identifying realistic, measurable, and specific goals that lead to clinical outcomes.
- Practice within regulations such as the Patient Protection and Affordable Care Act (PPACA) and the Health Information Technology for Economics and Clinical Health (HITECH) Act.
- Ability to work independently and in teams; Attention to detail; Handles large amounts of data; Analyze/interpret data.
Easterseals is a national 501(c)3 nonprofit organization that has helped children and adults with disabilities and special needs, live better lives for more than half a century. Annually, over 9,000 individuals with disabilities and specific special needs in New Jersey receive services in our programs. We believe everyone has an inalienable right to realize their potential and live their life as they envision it; everyone is allowed access to opportunities that permit them to do so.
Our employees dedicate themselves to making positive differences in people’s lives every day by living our Core Values: RESPECTFULNESS, WARMTH, EXPERTISE
Easterseals Is An Equal Opportunity Employer
As one of our core values, we strive to provide equal opportunity to all of our employees without regard to their age, gender, religion, race, color, national origin, marital status, sexual orientation, disability which is unrelated to the ability to perform essential job functions, unfavorable military discharge (except dishonorable), veteran status, marital status, parental status, genetic information, source of income or other legally protected category in accordance with applicable law with regard to receipt of services, appointment or election to voluntary office, or hiring for, assignment to, or promotion in staff positions.
About Easterseals New Jersey:
About Us!Easterseals is a national 501(c)3 nonprofit organization that has helped children and adults with disabilities and special needs, live better lives for more than half a century. Annually, over 9,000 individuals with disabilities and specific special needs in New Jersey receive services in our programs. We believe everyone has an inalienable right to realize their potential and live their life as they envision it; everyone is allowed access to opportunities that permit them to do so.
caravetterealestate.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caravetterealestate.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, caravetterealestate.com is the ideal place to find your next job.