Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance!

Metropolitan Jewish Health System; New York (NY); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking dedicated nursing professionals to join their team. This role involves processing service requests and collaborating with various healthcare disciplines to ensure members receive timely and effective care. Ideal candidates will have a strong background in nursing, particularly in long-term care or managed care settings, and will be equipped with excellent assessment skills. By joining this innovative firm, you will have the opportunity to make a significant impact on the lives of patients while working within a supportive and dynamic environment that values quality care and professional growth.

Qualifications

• Graduate of an accredited nursing program; Bachelor's degree preferred.
• Minimum of three to five years of nursing experience in long-term care or managed care.

Responsibilities

• Process all requests for services following Medicare and NYS Medicaid Guidelines.
• Collaborate with Care Managers and Physicians to ensure timely service delivery.

Skills

Nursing Experience

Assessment Skills

Utilization Management Knowledge

Knowledge of Medicare and Medicaid

Interqual Criteria Knowledge

Education

Bachelor's Degree in Nursing

Accredited Nursing Program Graduate

Tools

Windows

Microsoft Word

Microsoft 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, exemplify our commitment to expanding services to meet our patients' and members' needs. These high-quality healthcare plans aim to help individuals stay independent and live life on their own terms. Even in non-clinical roles, employees can positively impact the quality of our health plan members' lives.

Responsibilities

Process all requests for services following Medicare and NYS Medicaid Guidelines, along with departmental criteria. Collaborate with disciplines such as Care Managers, Assessment Nurses, Primary Care Physicians, and Specialists to ensure timely service delivery. Coordinate the completion of UAS NY assessments reflecting the current condition of the member. Ensure the member's Individualized Person-Centered Care Plan is up-to-date and accurately represents their current status.

Qualifications

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