Pre-Authorization RN

MJHS; Queens (KY); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Sign-on bonuses

Student loan assistance

Free MSN in Education

Tuition reimbursement

Dependent tuition reimbursement

Paid time off (including birthday)

Medical dental vision coverage

401(k) and Pension

Flexible spending

Job summary

MJHS is seeking a registered nurse to manage care coordination within Medicare and NYS Medicaid guidelines. You will work with the Care Manager, Assessment Nurse and PCP to ensure timely services and accurate UAS assessments.

The role requires an NY RN license, a Bachelor's degree preferred, and 3–5 years in long-term care, managed care, home care, geriatrics or hospice, with strong assessment skills and Interqual knowledge.

Qualifications

• Graduate of an accredited nursing program; Bachelor's degree preferred.
• Knowledge of Utilization management processes is 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.
• Working knowledge of Medicare and Medicaid regulations.
• Proficiency in Windows, Word and Excel.
• Strong assessment skills and knowledge of Interqual preferred.

Responsibilities

• Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Collaborates with Care Manager, Assessment Nurse and Primary Care Physician to ensure timely services.
• Coordinates timely completion of UAS NY assessment reflecting current member condition.
• Ensures the Individualized Person-Centered Care Plan is updated and accurate.

Skills

Utilization management

RN license

Interdisciplinary collaboration

Assessment skills

Medicare/Medicaid knowledge

Education

Bachelor's degree preferred

Tools

Windows

Word

Excel

Job description

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 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.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• Free MSN in Education program!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

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.

Qualifications

• 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

Min USD $90,000.00/Yr.

Max USD $110,000.00/Yr.