RN Pre-Authorization Supervisor — Utilization & Case Management

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. seeks a Registered Nurse supervisor to oversee MLTC/DSNP pre-authorization operations. The role involves ensuring regulatory timeframes, guiding complex cases, and coordinating interdepartmental communication.

Requirements include NY RN licensure, 1–3 years of management experience, and familiarity with utilization management, case management, and InterQual criteria.

Qualifications

• Graduate of an accredited nursing program; baccalaureate degree preferred.
• Minimum one to three years' management experience preferred.
• Previous managed care experience in utilization management and/or case management preferred.
• Minimum one year nursing practice in clinical settings (hospital, nursing facility, or home health).
• Licensed to practice as a Registered Nurse in New York with current registration.
• CCM preferred.
• Knowledge of InterQual and federal/state regulatory requirements for managed care.

Responsibilities

• Oversee day-to-day functioning of MLTC/DSNP pre-authorization functions.
• Review data to monitor regulatory requirements, timelines, and outcomes.
• Provide direction for complex cases and educate staff on new criteria trends.
• Serve as liaison for interdepartmental communication.

Skills

Management experience

Utilization management

Case management

Nursing practice

InterQual knowledge

Regulatory compliance

CCM preferred

Education

Bachelor of Science in Nursing (preferred)

Tools

InterQual

Job description

Metropolitan Jewish Health System, Inc. seeks a Registered Nurse supervisor to oversee MLTC/DSNP pre-authorization operations. The role involves ensuring regulatory timeframes, guiding complex cases, and coordinating interdepartmental communication.

Requirements include NY RN licensure, 1–3 years of management experience, and familiarity with utilization management, case management, and InterQual criteria.