Pre-Authorization Unit Supervisor

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. is seeking a Supervisor to oversee the MLTC/DSNP pre-authorization functions. You will supervise day-to-day operations, monitor regulatory time frames, and direct complex cases to ensure accuracy and compliance.

The role requires active nursing licensure in New York and experience in managed care. You will educate staff on new criteria trends (InterQual, policy changes) and coordinate interdepartmental communication to support patient care.

Qualifications

• Bachelor’s degree in nursing preferred; RN licensed in NY.
• 1–3 years of management experience preferred.
• Managed care experience in utilization or case management preferred.
• Minimum 1 year nursing practice in clinical settings.
• CCM certification preferred.
• Knowledge of InterQual and regulatory requirements for managed care.

Responsibilities

• Oversee day-to-day MLTC/DSNP pre-authorization operations.
• Monitor data to ensure regulatory timeframes and determinations.
• Provide direction for complex cases.
• Monitor pending cases.
• Educate staff on new criteria trends (InterQual, local policy, national determinations).
• Coordinate interdepartmental communication.

Skills

Nurse management

Utilization management

Case management

InterQual knowledge

Regulatory knowledge

NY RN license

CCM

Education

Bachelor's degree in Nursing

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.

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.

• 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.