Pre-Authorization Unit Supervisor

Metropolitan Jewish Health System; New York (NY); Vor Ort; USD 101.503 - 126.879; Vollzeit

Benefits dieser Stelle

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;

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Nursing management

Utilization management

Regulatory knowledge

InterQual knowledge

CCM preferred

Ausbildung

RN license in NY

Nursing degree graduate

Baccalaureate degree preferred

Jobbeschreibung

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.

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

The supervisor in this position is responsible for the oversight of the overall day to day functioning of the MLTC/DSNP pre-authorization functions. The supervisor’s daily oversight includes reviewing data to monitor regulatory requirements (standard/expedited time frames, org determination outcomes and communication, inter-rater reliability), provides direction for complex cases, monitors pending cases, reviews and educates staff on new criteria trends (including InterQual, local carrier policy, national coverage determinations), and acts as a liaison with interdepartmental communication.

Qualifications

• Graduate of an accredited nursing program: baccalaureate degree preferred.
• Minimum one to three years' previous management experience preferred.
• Previous managed care experience in the areas of utilization management and/or case management preferred.
• Minimum one year nursing practice in clinical settings, i.e. hospital, nursing facility or home health.
• Licensed to practice as a Registured 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.

Min

USD $101,503.41/Yr.

Max

USD $126,879.27/Yr.