Pre-Authorization RN

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

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. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member's Individualized Person-Centered Care Plan has been updated and accurately reflects present status of the member.

• Graduate of an accredited nursing program, Bachelor's preferred
• Knowledge with Utilization management processes preferred
• Current NY RN license and registration required
• CCM preferred
• Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Medicare and Medicaid regulations
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Windows, Word and Excel
• Knowledge of current standards of medical practice and healthcare delivery systems
• Strong assessment skills
• Knowledge of Interqual preferred