PreAuthorization RN

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. is seeking a registered nurse in New York to manage and coordinate services for Medicare and NYS Medicaid members.

The role focuses on timely assessment and care planning within an interdisciplinary team to support independent living for members. You will collaborate with Care Managers, Assessment Nurses, and physicians to ensure accurate assessments and up-to-date care plans, while maintaining compliance with regulatory guidelines in a long-term care or

Qualifications

• RN license and registration required in NY
• Bachelor’s degree from an accredited nursing program, preferred
• 3–5 years nursing experience in long-term care, managed care, home care, geriatrics or hospice
• Knowledge of Medicare & NYS Medicaid regulations
• CCM preferred
• Experience in an interdisciplinary service delivery environment preferred
• Knowledge of InterQual preferred

Responsibilities

• Processes all requests for services per Medicare and NYS Medicaid guidelines.
• Collaborates with Care Manager, Assessment Nurse and Primary Care Physician to ensure timely service provision.
• Coordinates timely completion of UAS NY assessments reflecting member’s current condition.
• Ensures the member’s Individualized Person-Centered Care Plan is updated to reflect current status.

Skills

RN license

Assessment skills

Interdisciplinary collaboration

Medicare/Medicaid knowledge

Windows/Word/Excel

Education

Bachelor's degree preferred

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