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Medical Management Clinical Coordinator - New York, NY
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | New York, NY New York, New York |
About this job
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Medical Management Clinical Coordinator will work as an integral member of the Medical Management team. Responsibilities will include collaboration with New York State Medicaid Health Homes, Accountable Care Communities, Federally Qualified Health Centers and the PCCM (Person Centered Care Models) Community Health Workers in order to support affordability initiatives, increase member engagement and reduce gaps in care. The job may include interaction and collaboration with team members who facilitate the UR/UM process, the Fair Hearings process, and provider and member outreach.
Primary Responsibilities:
Position will interact in a professional manner with clinical team, regulatory partners, members and providers as needed to prepare each case
The individual will have responsibility for the Medical Management committee functions (HQUM, Provider Relations, etc.)
Preparation and submission of medical management documentation to the State, such as UR licensing, as well as research, data analysis and submission for NCQA, Article 44/49 audits and other reports as required by the State of New York
The Medical Management Clinical Coordinator will work as an integral member of the Medical Management team. Responsibilities will include collaboration with New York State Medicaid Health Homes, Accountable Care Communities, Federally Qualified Health Centers and the PCCM (Person Centered Care Models) Community Health Workers in order to support affordability initiatives, increase member engagement and reduce gaps in care. The job may include interaction and collaboration with team members who facilitate the UR/UM process, the Fair Hearings process, and provider and member outreach.
Primary Responsibilities:
Position will interact in a professional manner with clinical team, regulatory partners, members and providers as needed to prepare each case
The individual will have responsibility for the Medical Management committee functions (HQUM, Provider Relations, etc.)
Preparation and submission of medical management documentation to the State, such as UR licensing, as well as research, data analysis and submission for NCQA, Article 44/49 audits and other reports as required by the State of New York
Requirements
Required Qualifications:
Current and unrestricted RN license in New York State
3 or more years of years clinical experience with at least 2 years experience in the managed care setting
Case management certification and/or 2 years case management experience is preferred
Excellent written and verbal communication skills
Ability to build and maintain relationships with provider community will be essential
Strong Computer skills
Reliable transportation to travel to member homes or other locations within service delivery area
Preferred Qualifications:
A Bachelor's degree is preferred
A managerial background is a plus
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, Registered Nurse; Health Homes; Qualified Health Centers; Community Health; Utilization Management; Utilization Review; NCQA; Case Management
Current and unrestricted RN license in New York State
3 or more years of years clinical experience with at least 2 years experience in the managed care setting
Case management certification and/or 2 years case management experience is preferred
Excellent written and verbal communication skills
Ability to build and maintain relationships with provider community will be essential
Strong Computer skills
Reliable transportation to travel to member homes or other locations within service delivery area
Preferred Qualifications:
A Bachelor's degree is preferred
A managerial background is a plus
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, Registered Nurse; Health Homes; Qualified Health Centers; Community Health; Utilization Management; Utilization Review; NCQA; Case Management