job details

Job Number: 1225832
Job Title: Care Planner (RN)
Job Type: Full-time
Location: Monroe, NY
Hours: Monday - Friday, 9am - 5pm
Post Date: Aug 9 2018
Salary: DOE
Detailed Job Description:
Fast paced and fast growing MLTC based client is hiring multiple RNs!

The Care Planner is responsible for the ongoing initiation of the Plan of Care for the members. The Care Planner determines the covered and non-covered benefits that will be provided for the member upon enrollment and during the length of enrollment.

* Interventions in the care plan, and creating authorizations for the covered benefits that member is eligible for.
* The Care Planner determines changes to members plan of care at time of request and is responsible to approve or deny services based on eligibility.
* Responsible for entering the Problems, Goals and Interventions in the care plan, updating all necessary documentation and closing the plan of care in a timely manner.
* Responsible for entering the appropriate authorizations upon approval of service.
* Responsible for documenting the members chart with justification for all determinations
* Responsible for creating action notices upon denial or decrease of service.
* Responsible for attending Fair Hearings to defend the determination of services
* Responsible for communicating with MD for information as necessary
* Responsible for communicating with Care Managers in regards to members services.
* Assist with running reports on UM projects
* Responsible to attend a Fair Hearing when requested, to defend the decision that has been made regarding a members services.
* Other duties as identified as a necessary part of employees role/



Client offers medical, dental, vision coverage, company paid life insurance, long term disability, and paid time off.

Don't wait -- apply today for immediate consideration!
Required Skills:
* Registered Nurse; BSN
* 2 years satisfactory office experience
1+ years of experience in Managed Care.
* Ability to read and interpret documents, determine eligibility for covered services and assess the need for necessary services based on policies, medical knowledge and prior experience. Ability to speak
effectively with members and employees of the agency.
* Good Organizational writing, communication and interpersonal skills.
* Able to assess member's situation by reading documentation in the chart.
* Word Processing/Spread Sheets
* Data Entry
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