RN: Pre-Authorization & Care Coordination (Managed Care)

MJHS; New York (NY); On-site; USD 85,000 - 110,000; Full time

Job summary

MJHS in Nassau County, NY seeks a skilled registered nurse to serve as Case Manager within our aging services teams. You will assess member needs, coordinate services, and ensure care plans reflect current status.

This role requires an NY RN license, 3–5 years in long-term care or related fields, and knowledge of Medicare/Medicaid guidelines. Collaborate with Care Managers, Assessment Nurses, and physicians to deliver timely, person-centered care in accordance with regulatory standards.

Qualifications

• Graduate of an accredited nursing program, Bachelor’s 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
• Knowledge of Interqual preferred
• Knowledge with Utilization management processes preferred
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Windows, Word and Excel

Responsibilities

• 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.

Skills

Strong assessment skills

Utilization management

Medicare/Medicaid regulations

Interdisciplinary collaboration

CCM preferred

Education

Bachelor’s degree in Nursing

Tools

Windows

Word

Excel

Job description

MJHS in Nassau County, NY seeks a skilled registered nurse to serve as Case Manager within our aging services teams. You will assess member needs, coordinate services, and ensure care plans reflect current status.

This role requires an NY RN license, 3–5 years in long-term care or related fields, and knowledge of Medicare/Medicaid guidelines. Collaborate with Care Managers, Assessment Nurses, and physicians to deliver timely, person-centered care in accordance with regulatory standards.