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

MJHS; Queens (KY); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Sign-on bonuses

Student loan assistance

Free MSN in Education

Tuition reimbursement

Dependent tuition reimbursement

Paid time off (including birthday)

Medical dental vision coverage

401(k) and Pension

Flexible spending

Job summary

MJHS is seeking a registered nurse to manage care coordination within Medicare and NYS Medicaid guidelines. You will work with the Care Manager, Assessment Nurse and PCP to ensure timely services and accurate UAS assessments.

The role requires an NY RN license, a Bachelor's degree preferred, and 3–5 years in long-term care, managed care, home care, geriatrics or hospice, with strong assessment skills and Interqual knowledge.

Qualifications

• Graduate of an accredited nursing program; Bachelor's degree preferred.
• Knowledge of Utilization management processes is 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.
• Working knowledge of Medicare and Medicaid regulations.
• Proficiency in Windows, Word and Excel.
• Strong assessment skills and knowledge of Interqual preferred.

Responsibilities

• Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Collaborates with Care Manager, Assessment Nurse and Primary Care Physician to ensure timely services.
• Coordinates timely completion of UAS NY assessment reflecting current member condition.
• Ensures the Individualized Person-Centered Care Plan is updated and accurate.

Skills

Utilization management

RN license

Interdisciplinary collaboration

Assessment skills

Medicare/Medicaid knowledge

Education

Bachelor's degree preferred

Tools

Windows

Word

Excel

Job description

MJHS is seeking a registered nurse to manage care coordination within Medicare and NYS Medicaid guidelines. You will work with the Care Manager, Assessment Nurse and PCP to ensure timely services and accurate UAS assessments.

The role requires an NY RN license, a Bachelor's degree preferred, and 3–5 years in long-term care, managed care, home care, geriatrics or hospice, with strong assessment skills and Interqual knowledge.