DME Review Coordinator

• Ensure high quality, cost-effective care, and services for Elderplan/HomeFirst members through the processing, review, and authorization of Durable Medical Equipment
• Make first level determinations, under the support of a Registered Nurse, utilizing Medicare’s National and Local Carrier Policy, Medicare based Interqual criteria for DME, internal Medical Policy, and physician/Medical Director support for medical necessity decisions
• Manage the collection of supporting medical documentation, application of criteria, manage the physician advisor review process as needed, update the outcome of the review process in EP’s case management system, and manage the member/provider notification of determination process, within CMS/DOH regulatory requirements

• High School Diploma or equivalent
• Two years prior managed care experience required
• Prior experience in a health care setting preferred
• Familiarity with utilization management/case management
• Excellent customer service including written and oral communication skills
• Ability to us the telephone, fax, e-mail, scanner, Microsoft Word, Excel, and capacity to learn other programs as assigned
• Good analytical abilities for problem solving
• Ability to be empathetic and understanding
• Ability to handle confidential aspects of the position
• Ability to work closely maintain collegiate relationships with different professionals as part of an interdisciplinary health care team
• Ability to prioritize tasks and meet set deadlines
• Appropriately allocate resources, maximize efficiency, and contain costs
• Ability to work independently while recognizing issues having departmental or organizational impact
• Assess members' needs and identify opportunities for recommending levels of care
• Ability to handle a high volume of outbound phone calls along with written documentation

college degree preferred

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