Job description
- Full-time
- (Hybrid)
Position Overview:
- The ideal candidate will be responsible for leading, implementing, and monitoring the organization’s Managed Care Organization (MCO) program.
- You will also ensure that the agency implements the appropriate infrastructure to support appropriate reimbursement and update the program as needed.
- Makes recommendations to the agency for the program’s ongoing support, growth, and development.
- Collaborates field service providers and internal departments to ensure consumers are at the appropriate level of care.
- Designs a functional and efficient program to prepare for MCO based payment.
- Performs the ongoing evaluation of the system, staff and agency needs.
- Monitors the efficiency and efficacy of Prior Authorization.
- Supports the MCO Specialist in the maintenance and monitoring of authorizations.
- Reviews Authorizations to ensure that information meets the clinical standards of services rendered.
- Navigates the Electronic Health Record to find data and support level of care recommendations.
- Interacts regularly with MCO’s to follow up on any outstanding issues.
- Collaborates with internal departments to secure necessary information for the program.
- Creates Payer Rule Informational Material
- Ensures compliance and monitors the financial stability of the program.
- Makes recommendations for program improvements when needed.
- Must be a Registered Nurse in New Jersey.
- Proven experience working with MCOs in the Behavioral Health field.
- 10 + years’ experience working with consumers who have psychiatric diagnosis.
- Minimum of five (5) years of supervisory experience.
- Familiar with various MCO’s and process to seek approval.
- Detail oriented; Organized; Can manage multiple priorities
- Skilled communicator (verbal and written).
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.
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