Utilization Mgmt RN - Pre-Auth & Care Coordination

Metropolitan Jewish Health System, Inc.; Oceanside (NY); On-site; USD 75,000 - 105,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. is seeking a registered nurse to coordinate utilization management and care planning for Medicare/Medicaid beneficiaries in New York.

The role collaborates with Care Managers, Assessment Nurses, PCPs and specialists to ensure timely service delivery and accurate UAS NY assessments. Responsibilities include updating individualized care plans and ensuring compliance with Medicare and NYS Medicaid guidelines, with preference for candidates experienced in

Qualifications

• Graduate of an accredited nursing program; Bachelor’s preferred.
• Current NY RN license and registration required.
• Minimum 3–5 years nursing experience in long-term care, managed care, home care, geriatrics or hospice.
• Knowledge of Medicare and NYS Medicaid regulations.
• Strong assessment skills; InterQual knowledge preferred.
• Prior experience in an interdisciplinary service delivery environment preferred.

Responsibilities

• Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Collaborate with Care Manager, Assessment Nurse and Primary Care Physician or other Specialists to ensure timely provision of services.
• Coordinate timely completion of UAS NY assessment that accurately reflects current condition of the member.
• Ensure that the member’s Individualized Person-Centered Care Plan has been updated and accurately reflects present status of the member.

Skills

Assessment skills

Utilization management

Medicare/Medicaid regulations

Interdisciplinary collaboration

MS Office (Windows/Word/Excel)

Education

Bachelor’s degree in Nursing (preferred)

Graduate of accredited nursing program

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System, Inc. is seeking a registered nurse to coordinate utilization management and care planning for Medicare/Medicaid beneficiaries in New York.

The role collaborates with Care Managers, Assessment Nurses, PCPs and specialists to ensure timely service delivery and accurate UAS NY assessments. Responsibilities include updating individualized care plans and ensuring compliance with Medicare and NYS Medicaid guidelines, with preference for candidates experienced in