Utilization Management RN — Geriatrics & Home Care

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

Job summary

Metropolitan Jewish Health System, Inc. is seeking a registered nurse in New York to manage and coordinate services for Medicare and NYS Medicaid members.

The role focuses on timely assessment and care planning within an interdisciplinary team to support independent living for members. You will collaborate with Care Managers, Assessment Nurses, and physicians to ensure accurate assessments and up-to-date care plans, while maintaining compliance with regulatory guidelines in a long-term care or

Qualifications

• RN license and registration required in NY
• Bachelor’s degree from an accredited nursing program, preferred
• 3–5 years nursing experience in long-term care, managed care, home care, geriatrics or hospice
• Knowledge of Medicare & NYS Medicaid regulations
• CCM preferred
• Experience in an interdisciplinary service delivery environment preferred
• Knowledge of InterQual preferred

Responsibilities

• Processes all requests for services per Medicare and NYS Medicaid guidelines.
• Collaborates with Care Manager, Assessment Nurse and Primary Care Physician to ensure timely service provision.
• Coordinates timely completion of UAS NY assessments reflecting member’s current condition.
• Ensures the member’s Individualized Person-Centered Care Plan is updated to reflect current status.

Skills

RN license

Assessment skills

Interdisciplinary collaboration

Medicare/Medicaid knowledge

Windows/Word/Excel

Education

Bachelor's degree preferred

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System, Inc. is seeking a registered nurse in New York to manage and coordinate services for Medicare and NYS Medicaid members.

The role focuses on timely assessment and care planning within an interdisciplinary team to support independent living for members. You will collaborate with Care Managers, Assessment Nurses, and physicians to ensure accurate assessments and up-to-date care plans, while maintaining compliance with regulatory guidelines in a long-term care or