Impact-Driven Pre-Authorization RN (Managed Care)

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. seeks an experienced Registered Nurse to support utilization management and care coordination within our Medicare/Medicaid programs.

You will collaborate with Care Manager, Assessment Nurse and Primary Care physicians to ensure timely service provision and accurate UAS NY assessments, maintaining an up-to-date individualized care plan. NY RN license required; CCM preferred.

Qualifications

• Graduate of an accredited nursing program; Bachelor's preferred.
• Current NY RN license and registration required.
• Minimum 3–5 years nursing experience in long-term care, managed care, home care, geriatrics or hospice.
• Knowledge of Medicare/Medicaid regulations.
• Strong assessment skills and experience in interdisciplinary teams.

Responsibilities

• Process all requests for services under Medicare and NYS Medicaid guidelines.
• Coordinate timely completion of UAS NY assessments reflecting member condition.
• Ensure care plans are updated to reflect current status.

Skills

Strong assessment skills

Knowledge of InterQual

Medicare and Medicaid regulations

Windows

Word

Excel

CCM preferred

Education

Graduate of an accredited nursing program, Bachelor's preferred

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System, Inc. seeks an experienced Registered Nurse to support utilization management and care coordination within our Medicare/Medicaid programs.

You will collaborate with Care Manager, Assessment Nurse and Primary Care physicians to ensure timely service provision and accurate UAS NY assessments, maintaining an up-to-date individualized care plan. NY RN license required; CCM preferred.