Senior Managed Care Coordinator
: Job Details :

OverviewSt. John's Riverside Hospital is a leader in providing the highest quality, compassionate health care utilizing the latest, state-of-the-art medical technology. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.St. John's has been an integral part of the community since the 1890's and its' commitment to provide the community with the most advanced medical services available continues to be the hospitals' vision, mission and value. St. John's Riverside Hospital built itself around an early foundation of nursing and community service. In 1894, the Cochran School of Nursing, the oldest hospital-based school of nursing in the metropolitan area, was founded, thus making the St. John's Nursing Staff more than just the backbone of the hospital, but the heart and soul. St. John's dedicated nurses give superior attention to those who need it most with a strong emphasis on patient and family-focused nursing care.St. John's Riverside Hospital staff is committed to making life better for all patients. The hospital continues to elevate the services provided with the goal of increasing the quality of life for all who entrust St. John's Riverside Hospital to their care.Personalized care together with advanced technology is what it means to be Community StrongResponsibilitiesThe Senior Managed Care Coordinator will coordinate the provision of inpatient chemical dependency treatment services with third party payers, including commercial insurers and managed care companies. The Senior Managed Care Coordinator will assists in the development and education of Managed Care staff and assists the Assistant Director with scheduling. Responsabilities includes :Responsible for participating in the development and education of new departmental employees. Responsibilities include, but are not limited to, educating the new employee on the vision, mission, function, theoretical framework, and goals of the department. Ensuring the new employees understand departmental polices and procedures for a successful transition to independence in work performance post orientation; Coordinate inpatient care through entire treatment cycle; Facilitate authorization and concurrent review processes for all third party insured inpatients; Work collaboratively and collect all relevant information from medical staff, and other BHS staff, needed to present patient case to Managed Care/Behavioral Health Organization to attain proper authorization for patient stays; Maintain and disseminate updated insurance and Managed Care/Behavioral Health Organization information including changes in managing entities, plan changes, hours of operation, contact information and all other relevant information with regards to authorization policies and procedures; Work in conjunction with BHS Central Intake staff on coordination of patient's insurance benefits; Performs care management functions for patients as needed. Provides and maintains resources for patients who are discharged from The Patient Welcome Center; Maintain relationships with other agencies and individuals wishing to make referrals to the program; Remain current on policies and procedures of insurance companies to facilitate coordination of program's financial responsibilities; Maintain and prepare statistical data, reports, and correspondence as required for agency, county and state, as assigned; Assists in the supervision of, students and volunteers as assigned; assists in student evaluations; Maintain clinical records in compliance with all regulatory bodies and SJRH/BHS policies and procedures; Assists in coordinating services with relevant agencies for individual clients and refer clients to other program as needed; Refers cases regarding quality of care and utilization issues to appropriate administrator i.e. Assistant Director of Case Management; Assists the Assistant Director for the completion and accuracy of the holiday and weekend schedules and daily schedules to ensure there is adequate coverage on a daily basis; Assists with orientation for newly hired staff. Orientation includes 6 week long orientation plan; Completes the new employee checklist validation tool for reviewing all departmental policies and procedures; Educates new employees to the mission, vision, structure, theoretical framework, and departmental goals; Assist leadership with creating the monthly staff meeting agenda , presenting the deliverables, and maintaining the staff meeting attendance; Assists in the interviewing of potential new departmental candidates; Assumes other related responsibilities as assignedQualificationsCASAC, LMSW, LMHC or other NYS recognized QHP required. Five or more years of treatment experience specific to chemical dependency treatment is required; inpatient detoxification and rehabilitation experience preferred. 3-5 years of experience dealing with managed care/ insurance companies is required.