Action-oriented and eager to embrace new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
A good decision-maker, with proven success at making timely decisions that maintain high standards of patient care within the organization.
Actively seeking new ways to grow and be challenged, using both formal and informal development
Approachable and comfortable with diverse groups of people and able to make others comfortable with you.
An effective communicator, capable of determining how best to reach different audiences and executing communications based on that understanding.
Capable of building strong customer relationships and delivering customer-centric
Evaluate and respond to clinical and administrative denials referred to Case Management Department for appeal.
Participate in the daily management of the denials through resolution after the appeal is filed.
Perform chart reviews to support strategic planning initiatives.
Work with multidisciplinary team and acts as a liaison to insurance carriers and staff.
Perform utilization management/concurrent review for the inpatient population when necessary.
You need :
Current NYS Registered Nurse License/Registration and BSN required
3-5 years acute hospital care experience
Experience with insurance industry and/or experience in reading and interpreting medical records strongly preferred.
Managed care/UR/CM experience strongly preferred.
Knowledge of state and federal regulations that affect health insurance coverage.
Strong writing skills required
Oncology experience preferred
Excellent interpersonal, problem solving and communication skills essential
Internal Number: 2019-38315
About Memorial Sloan-Kettering Cancer Center
As one of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, and superb educational programs. The close collaboration between our physicians and scientists is one of our unique strengths, enabling us to provide patients with the best care available today as we work to discover more effective strategies to prevent, control, and ultimately cure cancer in the future. Our education programs train future physicians and scientists, and the knowledge and experience they gain at Memorial Sloan-Kettering has an impact on cancer treatment and the biomedical research agenda around the world.