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16 Medicaid Service Coordinator jobs match your search criteria.

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Job Description: Medicaid Service Coordinator Medicaid Service Coordinator Location: New York, NY Salary: $16-$17 per hour Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1016244       About the Opportunity A premier healthcare organization located in New York City is actively seeking a self-motivated and patient-oriented professional for a promising opportunity on their staff as a Medicaid Service Coordinator. In this role, the Medicaid Service Coordinator will be responsible for coordinating the individual service plans of children and families in need, in accordance with the procedures and policies of the Office of People with Developmental Disabilities (OPWDD) and the organization. Apply today! Company Description Healthcare Organization Job Description The Medicaid Service Coordinator: Meets with families and explain MSC and the MSC role Conducts face-to-face and home visits as required by care needs and OPWDD regulations Coordinates access and delivery of supports and services Ensures that a person-centered planning process in delivering services is documented and updated as appropriate Ensures all relevant parties are aware of all progress (or lack of) in a timely manner in the implementation of the individual service plan Required Skills Bachelor's Degree with at least 20 credits in health or human services; or at least 60 credits in Health or Human Services and 1 year of experience working with the developmentally disabled; or 1 year of experience as a Service Coordinator with any population Strong medical skills and knowledge Demonstrated understanding of Medicaid Ability to multitask Excellent communication skills Strong attention to detail Desired Skills Bachelor's Degree in Social Work or Health and Human Services Bilingual, English and Spanish

Job Description: Medicaid Service Coordinator Medicaid Service Coordinator Location: Riverhead, NY Salary: $15-$18 per hour Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1015345       About the Opportunity An adoption agency on Long Island is currently seeking a new Medicaid Service Coordinator for a great opportunity with their growing staff. In this role, the Medicaid Service Coordinator will be responsible advocating for the consumers served by the agency by ensuring supports and services identified as part of the Individualized Services Plan (ISPs) are met and maintained and ensuring that accurate and current records are maintained. Apply today! Company Description Adoption Agency Job Description The Medicaid Service Coordinator will: Act as a direct link and advocate between the consumer and their services and supports Ensure completion of all waiver enrollment documents and maintain waiver eligibility Work with individual and their family and/or advocate to develop and maintain an annual Individualized Service Plan (ISP) Visit with individual on a minimum of three times a calendar year and documents the visit Actively seek and obtain services and support desired by the individual Ensure completion of Monthly Service Coordination Notes by the 10th of the following month Ensure completion of the annual Level of Care (LOC) by the 365th day Maintain a case file of the individual, which contains updated documentation, such as ISP, MSC Monthly Notes, Annual Physical, LOC, Evaluation, etc. Respond to emergencies after regular business, holidays, etc.  Required Skills 1+ year of experience working with people dealing with Developmental Disabilities Bachelor's Degree in a Health and/or Human Services field Solid data entry skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Master's Degree in a Health and/or Human Services field

Job Description: Health Services Program Director (NP) Health Services Program Director (NP) Location: New York, NY Salary: $80,000-$90,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J137730       About the Opportunity An established social services organization located in New York City is actively seeking a self-motivated and compassionate Nurse Practitioner (NP) to join their staff as a Program Director in their Health Services department. In this role, the Health Services Program Director will provide support and consultation to other programs across agency, and keep abreast of mandates as set forth by the regulatory agencies affecting health care and foster care. Apply today! Company Description Social Services Organization Job Description The Health Services Program Director (NP) will: Ensure participants residing at the facility receive services of highest quality and in compliance with agency, City, State, and Federal mandates Identify health and mental health resources, focusing on preventive health services for our youth and families Coordinate with health providers for youth in agency to ensure high quality, Medicaid compliant services are provided Provide/Arrange health and mental health education for staff, youth, and families Collaborate with Program Directors and Staff to ensure there is a multidisciplinary approach to care for youth Monitor, audit and ensure medical and health home charts have appropriate documentation Implement new Medicaid funded programming Update and/or develop any necessary procedural practices and provide training Provide strong leadership and clear communication to staff Collaborate with the other agency Health Services Program Directors for peer support and to ensure conformity of practice across programs Required Skills Graduate of an accredited nursing program Active New York State Nurse Practitioner license 5+ years of related experience Current American Heart/or American Red Cross Certification in infant, child, and adult Firm command of nursing principles and practices Ability to function as an educator and counselor to client, family and staff Familiar with and comfortable with electronic health records, Microsoft Office Suite Desired Skills BSN/MSN Successful completion of New York State HIV Counselor Training

Job Description: Supervisor / Director of Clinical Services (RN) Supervisor / Director of Clinical Services (RN) Location: Fairfield County, CT Salary: $90,000-$130,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J133093       About the Opportunity A Connecticut-based home care company is currently seeking a licensed Registered Nurse (RN) to join their growing staff as a Supervisor / Director of Clinical Services. In this role, the Supervisor or Director of Clinical Services (RN) will have the primary authority and responsibility for maintaining the quality of clinical services provided at company's Fairfield County facility. Company Description Home Care Company Job Description The Supervisor / Director of Clinical Services (RN) will be responsible for: Oversight of home health nursing, therapy, social work aide and homemaker services for the Home Health agency Overseeing the coordination of the patient care through the supervision of the clinical staff, including nursing, aide, social work, physical therapy, speech/language pathology and occupational therapy Safety and infection control, Quality Assurance and Performance Improvement, chart audits, and medical supplies Assuring that medical records are maintained appropriately and that all clinical disciplines function according to licensure, state and federal law for Home Health and  Accreditation Standards Assuming the role of the administrator in charge of the agency Required Skills 3+ years of experience in a Clinical Nursing; 1+ year of of experience in a Home Health or related Community Health Nursing setting; 1+ year of Supervisory experience Bachelor's or Master's Degree in Nursing from an accredited program or the equivalent CT Registered Nurse (RN) license Previous Case Management and and Medicaid / Medicare experience Solid documentation and assessment skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: UAS Field Nurse (RN) UAS Field Nurse (RN) Location: New York, NY Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1015374       About the Opportunity A widely recognized health insurance company in New York City is actively seeking a self-motivated and compassionate Registered Nurse (RN) for a promising UAS Field role on their staff. As a UAS Field Nurse, the qualified candidate will be responsible for conducting telephonic and face-to-face assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long term services and supports. Apply today! Company Description Health Insurance Company Job Description The UAS Field Nurse (RN): Identifies members with potential for high risk complications and coordinates treatment in conjunction with the member and the health care team Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services Obtains a thorough and accurate member history to develop an individual service plan Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, physicians Identifies members that would benefit from alternative level of care or other waiver programs Required Skills Nursing Diploma or ASN Active New York State Registered Nurse license Home health/field experience 2 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role Proficient in Microsoft Office programs, including Word, Outlook, and Excel Strong clinical skills and knowledge Desired Skills Bilingual, English and Mandarin or Spanish BSN Medicaid and managed care experience

Job Description: Case Manager (RN) Case Manager (RN) Location: Melville, NY Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1004635       About the Opportunity A recognized managed care company headquartered in Melville, NY is actively seeking a diligent Registered Nurse (RN) for a promising opportunity on their staff as a Case Manager. In this role, the Case Manager appropriately manages member care, including but not limited to; coordination of benefits (Medicare & Medicaid), coordinating and monitoring all skilled services, durable medical equipment (DME) and community resources. Company Description Managed Care Company Job Description The Case Manager (RN): Ensures high quality community-based member care through appropriate allocation of member services and resources Monitors and evaluates effectiveness of the care plan to ensure member/caregiver satisfaction with services Acts as a resource to staff in the planning and delivery of outstanding member care Maintains oversight and communication with members and providers during inpatient acute, sub-acute and/or long-term admissions Completes documentation in computer database of all member care Intervenes to resolve any grievances and/or concerns re: member care and safety Provides individual and group education and support to members and their families as needed  Maintains a current knowledge base of federal (Medicare) and state (Medicaid) regulations Identifies barrier and develops innovation solutions to ensure quality of member care Required Skills Active New York State Registered Nurse license Patient-oriented Clinical hospital experience Home care experience Excellent communication skills Strong phone assessment skills Exceptional computer skills Geriatric experience Knowledge of Medicare and Medicaid Desired Skills Prior experience in case management

Job Description: Early Intervention Biller Early Intervention Biller Location: New York, NY Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1006909       About the Opportunity A recognized healthcare organization headquartered in New York City is actively seeking a self-motivated and dynamic individual for a promising opportunity on their staff as an Early Intervention Biller. In this role, the Early Intervention Biller will provide administrative support and coordination of billing. Company Description Healthcare Organization Job Description The Early Intervention Biller will: Manage Related Services Authorization (RSA)/transmittal tracking and following up with clinicians Generate, review and analyze all billing functions for Early Intervention and related services Process Medicaid billing and private insurance billing adhering to all guidelines and tracking systems Handle all Early Intervention electronic billing and payment application/tracking Provide follow-up and appeals process for New York State Early Intervention and Medicaid billing discrepancies in a timely manner Complete required documents and electronic filing as required Assess the urgency and importance of issues and prioritizes action accordingly Follows mandatory guidelines according to the Corporate Policies and Procedures Manual Required Skills High School Diploma 2- 3 years of experience in accounting and/or billing Experience with Medicaid billing, Private insurance billing and New York State Early Intervention billing system (NYEIS) Experience in Accounts Receivable Comfortable working with multiple billing programs/systems Proficiency with Microsoft Office, including but not limited to Word, Excel, PowerPoint and Outlook Ability to work independently on projects and also collaborate as a strong team player Ability to communicate effectively both internally and externally to the appropriate parties Demonstrates initiative

Job Description: Bilingual Community Care Manager (RN) Bilingual Community Care Manager (RN) Location: New York, NY Salary: $80,000-$85,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J135821       About the Opportunity A premier health service provider in New York City is actively seeking a Spanish-speaking, licensed Registered Nurse (RN) for a promising opportunity on their staff as a Community Care Manager (RN). In this role, the Bilingual Community Care Manager (RN) works in collaboration with the member’s Primary Care Provider (PCP) and an interdisciplinary team to proactively manage members with complex medical, behavioral and psychosocial needs. Apply today! Company Description Health Service Provider Job Description The Bilingual Community Care Manager (RN) will: Conduct face-to-face and telephonic assessments of members’ functional status, medical, behavioral, psychosocial and community resource needs Organize Interdisciplinary Care Team (ICT) meetings and act as facilitator to ensure that members’ needs are met Develop an ICP based on members’ clinical, behavioral and social needs that incorporates barriers to care Coordinate and arrange for all services required by a member in accordance with the ICP Monitor members’ health status and ensure that member is receiving all necessary medical and supportive services Modify ICP as appropriate to member’s needs and progress Monitor/manage service utilization to optimize benefits to support access to services that improve health care outcomes Provide utilization management and issuance of appropriate authorizations for covered services Manage care transitions through effective and timely communication necessary for member care and discharge planning Clarify plan medical benefits, policies and procedures for members, providers and community based agencies Prepare for and participate in clinical case reviews to share best practices Adhere to documentation policies and procedures including documentation of Care Management activities and their effectiveness Required Skills Active New York State Registered Nurse license Bilingual (English and Spanish) Strong medical skills and knowledge Knowledge of chronic disease management Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management Outstanding communication skills Patient-oriented Competent in Microsoft Office Products (Outlook, Word, and Excel) Ability to work independently and maintain flexibly in a fast-paced start-up environment Ability to analyze data and use it to improve care delivery Desired Skills Knowledge of Medicare and Medicaid programs 2+ years of current clinical nursing experience with home care, case management, recent acute care experience, or physician office experience Medicare/Medicaid managed care experience Experience working with a geriatric population or equivalent experience

Job Description: Social Worker (LSW / LCSW) Social Worker (LSW / LCSW) Location: New York, NY Salary: $50,000-$60,000 Experience: 0.0 year(s) Job Type: Full-Time Job ID: J134749       About the Opportunity A healthcare facility in New York City is currently seeking a Licensed Social Worker (LSW) and/or Licensed Clinical Social Worker (LCSW) for a promising position with their growing medical staff. Reporting to the Supervisor of Care Management, the Social Worker will be responsible for formulating plans to provide oversight for the assistance of patients and their families in conjunction with the multi-disciplinary team. The facility is willing to train new graduates for the position. Apply today! Company Description Healthcare Facility Job Description The Social Worker: Performs an assessment of patient specific social, emotional and community service needs Works with interdisciplinary care team in creating a plan of care for a member to help improve health outcomes Identifies caregiver support needs in order to promote the psychosocial wellbeing and safety of the patient in their own environment Evaluates the appropriateness of an ongoing intervention and assess for the need to continue and/or change the intervention in order to promote a positive clinical outcome of that intervention Facilitates the enrollment and continuation of available community resources to support the patient's identified needs Assists with the coordination of the patient's health care and social service needs to optimize measurable clinical outcomes Provides resource information and training to nursing staff as needed Assists where needed in the 24/7 Caregiver Support Program Assists with the arranging of the patients' medical appointments and transportation services as an extension of the community nurse function Coordinates use of Community Center facilities and professional staffing needs under the guidance of the Supervisor of care Management Required Skills New Graduates are welcome! Bachelor's Degree in a related field Strong knowledge base and experience in local Social Service agencies Previous experience with Medicaid and Medicare Computer savvy Microsoft Office/Suite proficient Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills 3+ years of Social Work experience Degree in Sociology, Social Work or Psychology Bilingual (English and Spanish) Experience in a Medical environment

Job Description: Clinical Evaluation Manager (RN) Clinical Evaluation Manager (RN) Location: New York, NY Salary:  Experience: 3.0 year(s) Job Type: Temporary / Consulting Job ID: U1009028       About the Opportunity A Manhattan-based healthcare organization is actively seeking a compassionate and driven Registered Nurse (RN) for a promising opportunity on their staff as a Clinical Evaluation Manager. In this role, the Clinical Evaluation Manager improves clinical and cost-effective outcomes by reducing hospital admission and emergency department visits for members enrolled in Medicare and Medicaid, through on-going member education, care coordination and collaboration with providers of care. Company Description Healthcare Organization Job Description The Clinical Evaluation Manager (RN): Assesses, plans, facilitates and advocates for options and services to effectively manage an individual's health needs Leads the care coordination for complex clinical cases Promotes quality and cost-effective outcomes at all times Collaborates with physician and other healthcare professionals in managing coordination of care decisions related to case management and services Provides input and recommendations for design and development of policies, processes and procedures f Ensures compliance with state and federal regulatory standards and policies and procedures. Provides analysis of initial health evaluation and comprehensive assessment of the member/family psychosocial status and case management needs Performs other tasks as necessary Required Skills Active New York State Registered Nurse license Bachelor's or Master's Degree in Nursing 3+ years of experience in a managed care organization or acute inpatient hospital experience in chronic or complex care Excellent organizational and time management skills Strong interpersonal skills Excellent verbal and written communication skills Strong computer and typing skills  Desired Skills 2+ years' experience in utilization review with strong cost containment/case management Bilingual skills Knowledge of Medicare/Medicaid and/or commercial regulations

Job Description: Pre-Authorization Licensed Practical Nurse (LPN) Pre-Authorization Licensed Practical Nurse (LPN) Location: Brooklyn, NY Salary: $50,000-$59,000 Experience: 1.0 year(s) Job Type: Full-Time Job ID: J137525       About the Opportunity A respected healthcare facility in Brooklyn is actively seeking a self-motivated and compassionate Licensed Practical Nurse (LPN), with a strong Pre-Authorization background, for a promising opportunity on their staff. In this role, the Pre-Authorization LPN will process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Apply today! Company Description Healthcare Facility Job Description The Pre-Authorization Licensed Practical Nurse (LPN): Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member Ensures that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member Performs other tasks as necessary Required Skills Active Practical Nurse license Prior pre-authorization / Utilization Management experience Demonstrated case management skills Ability to multitask Excellent communication skills Strong interpersonal skills

Job Description: Nurse Case Manager (RN) Nurse Case Manager (RN) Location: New York, NY Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1002049       About the Opportunity A premier healthcare organization headquartered in New York City is actively seeking a driven and dynamic Registered Nurse (RN) for a rewarding opportunity on their staff as a Nurse Case Manager. In this role, the Nurse Case Manager will use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide ongoing coordination and management of service delivery through an integrated case management approach with utilization review and case management activities. Company Description Healthcare Organization Job Description The Nurse Case Manager will: Identify and solve issues with appropriate services to ensure positive member outcomes Provide an integrated holistic case management telephonic approach to those with chronic medical conditions Authorize vendor services using clinically proven criteria to make consistent care decisions Assist with discharge planning and care coordination to ensure optimal outcomes Maintain accurate record of case management assessment and intervention Promote active involvement and initiative to members regarding their health care management Communicate effectively with members, physicians, and providers  Perform additional duties and projects as assigned by management Required Skills High School Diploma or GED Active New York State Registered Nurse license 2 years of medical and surgical clinical experience, plus a minimum of one 1 year of case management, utilization review, or disease management experience Strong experience with discharge planning Strong knowledge of standard utilization criteria (Milliman, Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting provider contracts Ability to multitask Exceptional verbal and written communication skills Demonstrated  computer and organizational skills Results-driven Comfortable working in a fast-paced environment Desired Skills Telemetry skills Certified Case Manager

Job Description: Director of Vendor Management - Healthcare Director of Vendor Management - Healthcare Location: Bronx, NY Salary: $125,000-$180,000 Experience: 6.0 year(s) Job Type: Full-Time Job ID: 120583       About the Opportunity A healthcare organization is actively seeking an experienced professional for an excellent opportunity as a Director of Vendor Management with their staff. Reporting directly to the Vice President of Provider Relations and Network Development, the Director of Vendor Management will be responsible for maintaining vendor relations that support company-wide initiatives through strong contracts, due diligence and on-going vendor maintenance. Company Description Healthcare Organization Job Description The Director of Vendor Management will: Oversee vendor selection, due diligence oversight, and maintenance of vendor relationships Develop materials to evaluate vendors upon contracting and annual review Provide monthly reporting to measure vendor metrics and distribute to department heads or Delegated Vendor Oversight Committee as appropriate Represent the organization in vendor meetings Develop policies, contractual guidelines, and performance measures that are consistent with CMS and DOH requirements Work with compliance and quality to ensure policies and procedures are addressed and documented as downstream entities Implement new vendor arrangements Coordinate meetings with vendor and support departments such as IT, MM, CS, and Claims Ensure that work plan is kept on track and operational issues are identified and resolved up front prior to going live Identify new vendors for required service needs Identify and monitor vendor concerns, recommend solutions, and follow up during the process, as well as communicates resolution to ensure problems have been resolved Conduct financial analysis and reporting to evaluate potential cost savings Work with strategic planning to help senior staff make decisions on new cost saving initiatives Pursue and suggest pharmacy cost savings Conduct financial analysis as it relates to contract negotiations and on-going pharmacy initiatives Produce innovative ideas on how to improve pharmacy benefit programs and relationships Required Skills 6+ years of experience in Medicaid/Medicare, HMO/PPO, and Pharmacy Benefit Bachelor's Degree in related field Vendor management experience Strong Pharmacy experience Flexibility in traveling for on-site annual and pre-contractual audits Strong analytical and financial analysis skills Broad project management experience Ability to communicate effectively with different departments and levels within the organization Desired Skills Supervisory or Management experience

Job Description: ECC Case Manager (RN) ECC Case Manager (RN) Location: Massachusetts Salary:  Experience: 5.0 year(s) Job Type: Full-Time Job ID: J131811       About the Opportunity A medical center in Massachusetts is currently seeking a licensed Registered Nurse (RN) for a promising ECC Case Manager position with their growing staff. This is a fantastic opportunity for a dedicated ECC Case Manager (RN) to gain valuable work experience and further their career with an established facility in Bristol County. Company Description Medical Center Job Description The Case Manager (RN): Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care Communicates and negotiates with outside agencies, including insurance carriers, in order to obtain needed services for patients and accurate reimbursement for medical center Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care and communicates status of patients’ utilization and discharge plans to peers and Physicians Plans for care needs with active involvement of patient, significant other, hospital staff and Physicians involved in treatment process Monitors patient’s progress and adequacy of planning process through regular communication with patients and service providers Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality Completes Medical Director and Quality Referrals for management approval Provides Department Secretary with a list of the following days expected discharges by 2PM daily Completes insurance reviews by 1PM daily and provides outcomes to Physicians and, if necessary, facilitates a dialogue between Physician and health plan in a timely manner Identifies problems or gaps in community resources that impact outcomes and takes leadership role in efforts to effect changes Analyzes and organizes data to provide evidence for necessary process changes Participates actively in staff meetings, designated Hospital committees and community groups/task forces Required Skills 5+ years of current Acute Hospital or equivalent experience MA Registered Nurse (RN) license Expertise in Case Management / Utilization Review Knowledge of Medicare/Medicaid regulations Knowledge of age appropriate resources within the community (Infants, Pediatrics, Adolescents, Adults, and Geriatrics) Customer service oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Medicare Sales Manager Medicare Sales Manager Location: Miami, FL Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008025       About the Opportunity A driven and dynamic healthcare professional is currently being sought out by a premier healthcare organization in Miami for a promising opportunity on their staff as a Medicare Sales Manager. In this role, the Medicare Sales Manager will be responsible for oversight of Community Outreach and marketing efforts, direct-to consumer marketing and/or counseling, development of relationships with contracted providers and collaboration with Information Systems and Member Services Departments in order to ensure the highest level of customer satisfaction. Company Description Healthcare Organization Job Description The Medicare Sales Manager: Creates a pharmacy sales marketing plan for the target areas within the region to increase sales for all pharmacies Coordinates a marketing plan with the Marketing Department and outside consultants Prepares presentations for local and statewide staff meetings Maintains a pharmacy marketing report on a weekly and monthly basis for discussion and analysis Schedules, organizes and conducts sales training clinics with participating staff Ensures that the patient and provider satisfaction surveys are completed on a timely basis Submits enrollment materials to Managed Care Data Systems Participates in the development of the organization’s marketing materials Performs other tasks as required Required Skills Pharmaceutical Sales, Specialty Pharmacy Sales, and Management experience for Medicare and Medicaid health plans or closely related field Demonstrated leadership abilities Highly organized Ability to multitask Comfortable working independently and as a member of a team Proficiency with computer platforms and applications Strong communication skills Desired Skills Bachelor's Degree Experience in the Healthcare field, Marketing and sales and/or training 2-15 and 2-40 licensure

Job Description: Case Manager (RN) Case Manager (RN) Location: New York, NY Salary: $62,000-$77,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J131997       About the Opportunity A healthcare organization in New York City is actively seeking a licensed Registered Nurse (RN) for a rewarding Case Manager role with their medical staff. In this position, the Case Manager (RN) will be responsible for using industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide the ongoing coordination and management of service delivery through an integrated case management approach with utilization review and case management activities. Company Description Healthcare Organization Job Description The Case Manager (RN) will: Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services Provide an integrated holistic case management telephonic approach to those with chronic medical and behavioral health conditions with the goal of reducing the clinical gap between inpatient and outpatient services and potentially prevent hospital re-admissions Authorize vendor services using clinically proven criteria to make consistent care decisions Assist with discharge planning and care coordination to ensure optimal outcomes Maintain accurate record of case management assessment and intervention including benefit and cost analysis for data collection and trending Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources Communicate effectively with members, physicians, and providers; facilitate, advocate, and educate on the disease process Abide by and support the care management programs in order to ensure quality and efficient clinical operations Perform additional duties and projects as assigned by management Required Skills 2+ years of Medical and Surgical Clinical experience; 1+ year of Case Management, Utilization Review, or Disease Management experience NYS Registered Nurse (RN) license Strong experience with discharge planning Strong knowledge with standard utilization criteria (Milliman, Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting provider contracts Solid problem-solving, clinical assessment, and care planning skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized $ Desired Skills ASN / BSN

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Medicaid service coordinators help link patients with services they need to improve their quality of life. In these positions, coordinators advocate their patients and help them find resources they need to achieve a better quality of life.

Working closely with Medicaid recipients, service coordinators ensure their clients receive all the appropriate benefits they qualify for, including local, federal and charitable services. This includes finding services for their clients and helping them to complete the required paperwork.

To qualify for Medicaid service coordinator jobs, candidates need at least an associate’s degree in human services, social services, nursing or a related field, however, bachelor degrees are usually preferred. Excellent interpersonal skills are a must, because Medicaid service coordinators work closely with their clients, and many times, clients may choose their coordinator. Outside of working with clients, Medicaid service coordinators also deal with professionals across the healthcare spectrum both directly and remotely, so good oral and written communication skills are vital.

To find Medicaid service coordinator positions, search ADVANCE Healthcare Jobs today. Be sure to check out our Career Resource Center for the latest resume, cover letter and interview tips, along with more information on Medicaid service coordinator jobs.