Enrollment Quality Review Specialist

Overview

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

 

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

 

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

The Enrollment Quality Review Specialist is responsible for quality assurance, accuracy, and overall integrity of the all aspects of enrollment visit documentation including the UAS-NY assessment data, Person Centered Service Plan (PCSP), and Tasking Tool completed by core team nurses as well as, business partners’ nurses as it pertains to clinical follow-up and Not Taken Under Care (NTUC) documentation after enrollment visit completion. This responsibility is fulfilled by reviewing the Enrollment Visit Outcome Template, PCSP, and Tasking Tool to appropriately complete and submit cases for enrollment or NTUC. Additionally, the Enrollment QRS will complete transfer calls and deferral calls to Maximus in accordance with DOH regulations. This position is responsible for identifying trends that require staff re-training in collaboration with Clinical management staff.

Qualifications

• Baccalaureate degree in nursing required. Master's degree in nursing, education, or related field preferred
• Minimum of two (2) years clinical experience required.
• Computer literate, Windows, Excel, Word, Visio and data base programs required. Powerpoint preferred.
• Licensed with current Registration to practice as Registered Professional Nurse in NYS.
• Strong interpersonal and organizational skills.
• Excellent written and verbal communication skill.
• Excellent analytic skills, interpretation of data.
• Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulations.
• Work effectively within interdisciplinary team environment.
• Ability to set priorities and to handle multiple assignments.
• Working knowledge of audit techniques and methodologies.
• Working knowledge of State and Federal regulations.

Min

USD $92,276.31/Yr.

Max

USD $115,345.38/Yr.