RN - Care Coordination & Pre-Authorization

Metropolitan Jewish Health System; Oceanside (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

Metropolitan Jewish Health System seeks an experienced registered nurse to support utilization management and care coordination for Medicare/Medicaid plans. You will process service requests, coordinate UAS NY assessments, and ensure care plans stay aligned with patient status.

The role emphasizes collaboration with Care Managers, Assessment Nurses, and physicians in a long-term care or home care setting, with strong knowledge of Medicaid regulations and InterQual guidelines.

Qualifications

• Graduate of an accredited nursing program; Bachelor's degree 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.
• Prior experience in an interdisciplinary service delivery environment preferred.
• Knowledge of Medicare and NYS Medicaid regulations.

Responsibilities

• Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Coordinates timely completion of UAS NY assessment reflecting member’s condition.
• Ensures individualized care plan is updated to reflect present status.
• Works collaboratively with Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary.

Skills

Utilization management

InterQual

Assessment skills

Medicare/Medicaid regulations

RN license NY

Windows/Word/Excel

Interdisciplinary teamwork

Geriatrics/long-term care

Education

Bachelor's degree in Nursing

RN license in NY

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System seeks an experienced registered nurse to support utilization management and care coordination for Medicare/Medicaid plans. You will process service requests, coordinate UAS NY assessments, and ensure care plans stay aligned with patient status.

The role emphasizes collaboration with Care Managers, Assessment Nurses, and physicians in a long-term care or home care setting, with strong knowledge of Medicaid regulations and InterQual guidelines.