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MLTC Clinical Utilization RN

RiverSpring Living • Full-time • Bronx, NY, US • 2w ago

Overview

Do you have a passion for caring for older adults? If so you have found the right place to continue your career! Join our compassionate and dedicated team and make a difference in the lives of our members at RiverSpring Health Plans. RiverSpring Health Plans, serves over 18,000 frail and disabled individuals who choose to live in their homes and live independently for as long as possible. The Clinical Utilization Registered Nurse works directly with the Clinical Utilization Director in supporting clinical decisions for hospital and skilled nursing admissions, decisions on Personal Care Aide services for high hour cases, and decisions for high dollar medical equipment.

Responsibilities

The Clinical Utilization Registered Nurse is responsible for collaborating with Care Management in order to support the defense of fair hearings, PCA high hour decisions, and MAP admissions.

Qualifications

Current valid New York State license as Registered Professional Nurse. Bachelor’s Degree in nursing required. Minimum of two (2) years in managed care setting, Care Management, Utilization Management and/or Grievance and Appeals experience. Demonstrated knowledge of Medicare and Medicaid regulations. Strong analytical skills. Effective oral and written communication skills. Strong organizational skills. Thorough knowledge of personal computer, especially proficiency with Microsoft Word, PowerPoint, and Excel. Ability to work and manage problems independently.

Compensation: $95,000-$110,000 Annually

Our staff are our greatest asset and as such we offer an excellent and comprehensive benefits package which includes:

HEALTH & INSURANCE BENEFITS*

Medical and Prescription DrugCompany-Paid DentalCompany-Paid VisionCompany-Paid Life Insurance and Accidental Death & DismembermentCompany-Paid Short-Term DisabilityCompany-Paid Long-Term DisabilityHealth Care Flexible Spending AccountDependent Care Flexible Spending AccountEmployee Assistance PlanAdditional Life Insurance options for the employee and family membersAdditional Disability options403(b) Plan, with a generous employer contributionTIME OFF BENEFITS*HolidaysPersonal DaysSick DaysVacation

ADDITIONAL BENEFITS*Bereavement DaysCell Phone Discount PlanCommuter PlanJury Duty DaysMarriage DaysPet Insurance Discount PlanTuition AssistanceWellness ProgramsYears of Service Awards

*This information is subject to change and it is not meant to be a comprehensive explanation of our employee benefits. The benefits contained in this benefit summary could change at any time without notice.

EOE

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