RN Care Coordination & Pre-Authorization Specialist

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

Job summary

Metropolitan Jewish Health System seeks a registered nurse to coordinate utilization management and care planning for Medicare/Medicaid members in a long-term care context. You will work with Care Managers, Assessment Nurses, and physicians to ensure timely, compliant services and accurate patient records.

The role emphasizes interdisciplinary collaboration, strong assessment abilities, and knowledge of Medicare and Medicaid requirements, supporting patient independence and quality of life.

Qualifications

• Graduate of an accredited nursing program; Bachelor's preferred.
• Current NY RN license and registration required.
• CCM preferred; experience in long term care, managed care, home care, geriatrics or hospice.
• Knowledge of Medicare and NYS Medicaid guidelines and utilization management processes.

Responsibilities

• Process all requests for services per Medicare and NYS Medicaid guidelines.
• Collaborate with Care Manager, Assessment Nurse, and PCP or Specialists to ensure timely services.
• Coordinate timely UAS NY assessments reflecting member condition.
• Ensure Individualized Person-Centered Care Plan is updated and accurate.

Skills

InterQual knowledge

Utilization management

Assessment skills

Care coordination

Team collaboration

Education

Nursing degree

RN license NY

Bachelor's degree preferred

CCM preferred

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System seeks a registered nurse to coordinate utilization management and care planning for Medicare/Medicaid members in a long-term care context. You will work with Care Managers, Assessment Nurses, and physicians to ensure timely, compliant services and accurate patient records.

The role emphasizes interdisciplinary collaboration, strong assessment abilities, and knowledge of Medicare and Medicaid requirements, supporting patient independence and quality of life.