Pre-Authorization Unit Lead – Managed Care

Metropolitan Jewish Health System; New York (NY); On-site; USD 101,503 - 126,879; Full time

Benefits offered by this job

Sign-on bonuses or student loan assist

MSN in Education program

Tuition reimbursement

Dependent tuition reimbursement

Generous paid time off

Medical, dental and vision coverage

Two retirement plans: 403(b) and/p211;

Job summary

Metropolitan Jewish Health System (MJHS) seeks a nursing leader to oversee MLTC/DSNP pre-authorization operations. You will supervise daily workflow, monitor regulatory deadlines, and guide staff through complex cases while ensuring timely determinations across the program.

You will work with interdepartmental teams, stay current with InterQual and policy changes, and maintain high standards of quality, compliance, and patient-focused care within our managed care framework.

Qualifications

• Graduate of an accredited nursing program; baccalaureate degree preferred.
• 1–3 years of management experience preferred.
• Experience in managed care utilization management and/or case management preferred.
• Minimum 1 year nursing practice in clinical settings (hospital, nursing facility or home health).
• Licensed to practice as a Registered Nurse in the state of New York with current registration.
• CCM preferred.
• Knowledge of InterQual preferred.
• Knowledge of Federal and State regulatory requirements for managed care.

Responsibilities

• Supervise the MLTC/DSNP pre-authorization functions and day-to-day operations.
• Review data to monitor regulatory requirements and advise on complex cases.
• Educate staff on new criteria trends (InterQual, policy changes) and coordinate interdepartmental communication.

Skills

Nursing management

Utilization management

Regulatory knowledge

InterQual knowledge

CCM preferred

Education

RN license in NY

Nursing degree graduate

Baccalaureate degree preferred

Job description

Metropolitan Jewish Health System (MJHS) seeks a nursing leader to oversee MLTC/DSNP pre-authorization operations. You will supervise daily workflow, monitor regulatory deadlines, and guide staff through complex cases while ensuring timely determinations across the program.

You will work with interdepartmental teams, stay current with InterQual and policy changes, and maintain high standards of quality, compliance, and patient-focused care within our managed care framework.