Job Title

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.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 Reimbursementfor all full and part-time staffGenerous paid time off, including your birthday!Affordable and comprehensivemedical, dental and vision coverage for employee and family membersTwo retirement plans! 403(b) AND Employer Paid PensionFlexible spendingAnd MORE!MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)The Durable Medical Equipment (DME) Review Coordinator is expected to ensure high quality, cost-effective care, and services for Elderplan/HomeFirst members through the processing, review, and authorization of Durable Medical Equipment. The DME Review Coordinator is responsible for making 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. The DME Review Coordinator will 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. The position requires excellent communication, organizational skills, attention to detail, and knowledge of regulatory processes.High School Diploma or equivalent; college degree preferred.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 for communicating with vendors and providersAbility to us the telephone, fax, e-mail, scanner, Microsoft Word, Excel, and capacity to learn other programs as assignedGood analytical abilities for problem solvingAbility to be empathetic and understandingAbility to handle confidential aspects of the positionAbility to work closely maintain collegiate relationships with different professionals as part of an interdisciplinary health care teamAbility to prioritize tasks and meet set deadlinesAppropriately allocate resources, maximize efficiency, and contain costsAbility to work independently while recognizing issues having departmental or organizational impactAssess members' needs and identify opportunities for recommending levels of careAbility to handle a high volume of outbound phone calls along with written documentationUSD $51,000.00/Yr.USD $58,000.00/Yr.