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

Metropolitan Jewish Health System, Inc.; Oceanside (NY); On-site; USD 75,000 - 105,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. is seeking a registered nurse to coordinate utilization management and care planning for Medicare/Medicaid beneficiaries in New York.

The role collaborates with Care Managers, Assessment Nurses, PCPs and specialists to ensure timely service delivery and accurate UAS NY assessments. Responsibilities include updating individualized care plans and ensuring compliance with Medicare and NYS Medicaid guidelines, with preference for candidates experienced in

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 and NYS Medicaid regulations.
• Strong assessment skills; InterQual knowledge preferred.
• Prior experience in an interdisciplinary service delivery environment preferred.

Responsibilities

• Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Collaborate with Care Manager, Assessment Nurse and Primary Care Physician or other Specialists to ensure timely provision of services.
• Coordinate timely completion of UAS NY assessment that accurately reflects current condition of the member.
• Ensure that the member’s Individualized Person-Centered Care Plan has been updated and accurately reflects present status of the member.

Skills

Assessment skills

Utilization management

Medicare/Medicaid regulations

Interdisciplinary collaboration

MS Office (Windows/Word/Excel)

Education

Bachelor’s degree in Nursing (preferred)

Graduate of accredited nursing program

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