Remote, Full-time
The Writer/Editor works within Clinical Business Management and Operations and is responsible for editing/auditing written Utilization Management (UM) adverse determination letters across all Healthfirst’s managed care products, as well as Care Management (CM) Person Center Service Plan (PCSP) letters. The Writer/Editor will independently and accurately audit, edit and compose/generate a wide variety of member and provider correspondence to ensure compliance with State and Federal regulations.
Duties and Responsibilities:
- Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.
- Meet established time frames for completion of assigned correspondence.
- Identify deficiencies and provide feedback to reduce errors and improve processes and performance to ensure quality.
- Review and investigate a variety of member and provider correspondence to ensure all elements of the letter match what is in the Clinical system (TruCare) and ensure the correct template is being used appropriately.
- Collaborate with care managers in UM, CM, the leadership team and peer reviewers to comply with regulatory-mandated notices.
- Analyze/audit letters for appropriate medical terminology using departmental policies and federal and state regulations.
- Assist with the creation, storage, protection, retrieval, and retirement of letters to enrollees, providers and facilities from company systems.
- Ensure compliance with Healthfirst’s corporate branding requirements.
- Additional duties as assigned.
Minimum Qualifications:
- HS diploma or GED
- Excellent written and verbal communication skills
- Ability to work efficiently
- Critical/creative thinking and problem-solving skills.
- Work experience in healthcare
Preferred Qualifications:
- Article 44 and 49 of the NY State Public Health Law and Appendix F, Medicare Managed Care Manual Chapter 13 and/or commercial contracts and others as necessary.
- Associate’s degree in related allied health care field.
- Basic knowledge MS SharePoint preferred.
- Regularly uses moderately complex oral and written skills. May train others in functional areas and interact with others across Healthfirst and/or externally.
- Demonstrated flexibility to accommodate changes; approachable, neutral and objective approach.
- Experience with Utilization Management, government programs and managed care, including but not limited to, processing organizational determinations- approvals and denials, or appeals and grievance type of events.
Hiring Range*:
- Greater New York City Area (NY, NJ, CT residents): $47,403 – $62,400
- All Other Locations (within approved locations): $41,101 – $60,320
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
I am a pharmacist, community pharmacy consultant, and medical writer with over 12 years of clinical practice experience in community, outpatient health system, long term care, and academic settings. I am also the founder of PharmCompliance.com, a website dedicated to the success of community pharmacy.
As a pharmacy project manager, I led the implementation of new service lines, assist with ensuring legal and third-party compliance for over 70 retail stores, lead quality improvement and medication safety initiatives, write policies, procedures, and best practices for all our retail sites, and help with optimizing revenue cycle and pharmacy profitability. I have been responsible for DMEPOS and vaccine accreditation through CMS, obtaining new licenses and permits, and implementing a prescription drug kiosk embedded in our physician offices.
As a medical writer, my work has been featured in GoodRx, Pharmacy Times, Drug Topics, Patient Care Online, and in peer-reviewed journals. I have also given presentations on a range of topics, from disease state pharmacotherapy for medical residents to updates on the CDC vaccine storage and handling guidelines for a medical-grade refrigerator and freezer manufacturer. I have written and presented continuing education for CEImpact, FreeCE, AchieveCE, Ascension Health, and the Florida Department of Health.
