Managed Care Authorization Specialist

Overview

The Managed Care Authorization Specialist has overall responsibility for communicating and coordinating with managed care providers to ensure appropriate reimbursement services rendered to Menorah residents. This includes but is not limited to obtaining ongoing authorizations for services, submitting clinical documentation to support level of care and facilitating the appeal process and supporting the case management department.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive 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

• Maintain ongoing communication with Case Managers to resolve any issues which may impact service delivery
• Coordinates with Menorah staff to ensure that all needed documentation is submitted timely.
• Maintains continued authorization for Menorah residents while covered by Managed Care plans and as needed.
• Participates in Case Management Rounds and collaborates in the discharge planning process.

Qualifications

·       One-year prior managed care experience preferred

·       Prior experience in a health care setting preferred

·       Familiarity with utilization management/case management

·       Microsoft Office

·       Ability to present well, both verbally and written

Min

USD $46,640.15/Yr.

Max

USD $58,300.19/Yr.

Metropolitan Jewish Health System, Inc is one of the largest health systems in the region with range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care (Menorah and Isabella Center), and the research based MJHS Institute for Innovation and Palliative Care. They also offer health plans for Medicare and dual-eligible individuals.