Supervisor of Pre-Certification Support

4 weeks ago


New York, United States Metropolitan Jewish Health System Full time

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.

Oversees all aspects of the Precertification Support services regarding MAPD precertification requirements. The supervisor oversees and ensures compliance with CMS regulations and departmental policies including regulatory timeframes (standard/expedited time frames, org determination outcomes, and communication, inter-rater reliability); provides direction for complex cases; monitors pending cases; reviews and educates staff on criteria changes (including InterQual, Local Coverage Determinations (LCD), National Coverage Determinations NCD); and acts as a liaison with other departments.

Works closely with Supervisors of Case Management and Pre-Certification on all initiatives and unit functions.

  • Graduate of a health care associate degree program. Bachelor's degree in business, human services, or a health-related field preferred.
  • Minimum 3 years of Managed care experience in the areas of utilization management and/or case management required.
  • Proficiency in Microsoft Word, Excel, and Windows operating systems.
  • Excellent customer service, oral communication, writing, and typing skills. Excellent telephone assessment skills.
  • Working knowledge of utilization management processes Knowledge of Federal and State regulations and managed care regulations and concepts.
  • Ability to provide appropriate support and direction to facilitate collaborative efforts toward accomplishing Department goals and objectives.
  • Demonstrates knowledge/ability of Institutional goals and changing trends in healthcare and cost factors in delivering patient care.


  • New York, United States Metropolitan Jewish Health System Full time

    Overview: 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...


  • New York, United States Prutech Solutions Full time

    Job Description: Role. Hearing Support SupervisorLocation: 29 Gallatin Pl, Brooklyn, NY 11201Duration: 3+ YearsInterview Process: 1st Virtual round, 2nd In-person, 3rd Virtual round.Working Hours: Monday to Friday ( 8 AM to 5 PM ) Hearing Support SupervisorThe Hearing Support Supervisor is responsible for managing all functions in the HearingSupport unit....


  • New York, United States Brooklyn Community Services Full time

    Job DescriptionJob DescriptionPosition: Community Prevocational Trainer (DSP) Work Location: 691 Fulton Street, 2nd Fl. Brooklyn, New York 11217Hours: Full Time 35 hours per week; Monday - Friday from 8:30-4:30Salary Range: $16.50/hour - $18.00/hourPosition Summary: The responsibility of a Pre-Vocational trainer is to foster and engage individuals through a...


  • New York, United States Manhattan Youth Full time

    Job DescriptionJob DescriptionDescriptionThe Manhattan Youth Downtown Community Center is seeking a qualified, experienced Parent/Child & Pre-K Swim Instructor to join our Aquatics team.  Our program offers classes for swimmers of all ages and abilities, from infants through adults. Our teaching philosophy follows a child-centered approach, fostering joy...

  • Certification Engineer

    12 hours ago


    New York, United States Tekskills Full time

    Job Title: Certification Support Engineer (DO178B) Location: Everett, WA or Seattle, WA (On-site role) Duration: Fulltime Job Description: Cabin and interior system team at Boeing Commercial Airplanes is seeking passionate and energetic multi-disciplinary Mid-Level Avionics Engineers to join the team in defining and building the future of flight at Everett,...


  • New York, United States InterContinental Capital Group Inc Full time

    >> Support Specialist Supervisor - Internal Support Specialist Supervisor - Internal Summary Title:Support Specialist Supervisor - Internal ID:1483 - NYLocation:Melville, NYDepartment:Operations Description **About Intercontinental Capital Group** **:** Intercontinental Capital Group (ICG) is a rapidly-growing Mortgage Banker currently licensed in 45...


  • New York, United States Cherokee Nation Businesses Full time

    Job DescriptionCommunity Shelter Supervisor Please Note: This position is pending a contract award. If you are interested in a future with Cherokee Federal, APPLY TODAY! Although this is not an approved position, we are accepting applications for this future and anticipated need. The Community Shelter Supervisor will provide direct management and ongoing...

  • Assistant Supervisor

    4 weeks ago


    New York, United States City of New York Full time

    **THE SELECTED CANDIDATE WILL BE OFFERED A SALARY OF $73,** The Administration for Children’s Services (ACS) protects and promotes the safety and well-being of children and families through child welfare and juvenile justice services and community supports. ACS manages community-based supports and foster care services, and provides subsidized child care...


  • New York, United States ThreatWarrior Full time

    IT Networking and/or Cybersecurity Pre-Sales Engineer ThreatWarrior is seeking a Pre-Sales Engineer (SE) who is based in the Northeast US to build upon, implement and support our growing base of customers.  We are looking for someone that can hit the ground running in a fast-paced and quickly growing environment.  This is currently a remote position,...


  • New York, United States ThreatWarrior Full time

    Job DescriptionJob DescriptionIT Networking and/or Cybersecurity Pre-Sales EngineerThreatWarrior is seeking a Pre-Sales Engineer (SE) who is based in the Northeast US to build upon, implement and support our growing base of customers. We are looking for someone that can hit the ground running in a fast-paced and quickly growing environment. This is currently...

  • Pre-Sales Engineer

    2 weeks ago


    New York, United States DiD Full time

    D-ID is at the forefront of revolutionizing generative AI-powered interactions and content creation. Specializing in Natural User Interface (NUI) technologies, D-ID's platform seamlessly transforms images, text, videos, audio, and voice into highly engaging Digital People, offering a uniquely immersive experience.D-ID combines facial synthesis and deep...


  • New York, United States US Tech Solutions Full time

    Role: Pre-Silicon Emulation Engineer Duration- 12 months Location- Austin, TX Hybrid (3 days onsite) THE ROLE: With Client engineering teams, you will be exposed to the world’s best Desktop/PC and Mobile CPU, GPU and APU processors for accelerated system computing power. As a Client Engineer you will have visibility to cutting edge multi-layered security...


  • New York, United States Volunteers of America - Greater New York, Inc. Full time

    Volunteers of America-Greater New York (VOA-Greater New York) is an anti-poverty organization working to end homelessness in the New York area by 2050. We operate over 60 programs across New York City, Northern New Jersey and Westchester County including emergency, transitional and permanent housing. Our services extend to families experiencing homelessness,...

  • RN Supervisor

    1 day ago


    New York, United States NCG Associates Full time

    NCG Associates is a reputable healthcare staffing agency dedicated to providing exceptional nursing professionals to healthcare facilities nationwide. We are currently seeking an experienced and dynamic RN Supervisor to join our team. As an RN Supervisor at NCG Associates, you will play a crucial role in leading and managing a team of nurses to ensure the...

  • Pre-Sales Engineer

    2 weeks ago


    New York, United States DiD Full time

    D-ID is at the forefront of revolutionizing generative AI-powered interactions and content creation. Specializing in Natural User Interface (NUI) technologies, D-ID’s platform seamlessly transforms images, text, videos, audio, and voice into highly engaging Digital People, offering a uniquely immersive experience. D-ID combines facial synthesis and deep...

  • Pre-Sales Engineer

    1 month ago


    New York, United States D-ID Full time

    Job DescriptionJob DescriptionD-ID is at the forefront of revolutionizing generative AI-powered interactions and content creation. Specializing in Natural User Interface (NUI) technologies, D-ID’s platform seamlessly transforms images, text, videos, audio, and voice into highly engaging Digital People, offering a uniquely immersive experience.D-ID combines...


  • New York County, New York, United States The Symicor Group Full time

    The Position We seek to fill an RN – Clinical Coordinator (Pre-Surgical Screening) role in the New York, NY area. The candidate will focus on safe and efficient operations of the nursing staff, s/he will also partner with the PCD and onsite departments to develop and execute initiatives that enhance the patient and provider experience. The position...


  • New York, United States Iyaho Social Services Inc Full time

    Job DescriptionJob DescriptionJob Responsibilities of Direct Support Professional (DSP)Provides transportation for individual(s), by picking up individuals from their homes and transporting them to the day hab site; and transporting the individual(s)’ home from the day hab site, using the company’s vehicle. Transports individual(s) for community...


  • New York, United States TEPHRA Full time

    Description: Job Description • Deliver product value propositions and presentations to customers tuned to customer and industry needs • Attend meetings with sales & business development managers; serve as a technical expert • Put together business cases for the sales teams to support their proposals and assist Sales Team in Qualifying Prospects •...

  • Deck Supervisor

    4 hours ago


    New York, United States Boys Club of NY Full time

    **Position**: Deck Supervisor **Location**:321 East 111th St. New York, NY 10029 **Salary Range**:$35 per hour **Employment Type**: Part Time **About Us** Founded in 1876, The Boys’ Club of New York (BCNY) is a youth development organization with the mission to empower boys and young men, ages 7 to 21, by providing effective programs and a supportive...