Utilization RN - Pre-Authorization & Care Coordination

Metropolitan Jewish Health System, Inc.; Oceanside (NY); On-site; USD 90,000 - 110,000; Full time

Job summary

Metropolitan Jewish Health System, Inc. seeks an experienced registered nurse to support utilization management and care coordination for Medicare/Medicaid plans. You will collaborate with Care Managers, Assessment Nurses and physicians to ensure timely services and accurate assessments.

Responsibilities include completing UAS NY assessments, updating person-centered care plans, and applying current standards of medical practice within a interdisciplinary team.

Qualifications

• Graduate of an accredited nursing program, Bachelor's preferred.
• Current NY RN license and registration required.
• Knowledge of Medicare and NYS Medicaid guidelines preferred.
• Strong assessment and interdisciplinary collaboration skills.
• Familiarity with utilization management processes a plus.
• Experience in long term care, managed care, home care, geriatrics or hospice preferred.

Responsibilities

• Processes all requests for services in accordance with Medicare and NYS Medicaid Guidelines.
• Coordinates timely completion of UAS NY assessments reflecting member condition.
• Ensures that the Individualized Person-Centered Care Plan is current and accurate.

Skills

RN license NY

CCM preferred

Utilization management

Assessment skills

Medicare/Medicaid knowledge

Interdisciplinary teamwork

Windows/Word/Excel

Education

Graduate of accredited nursing program

Bachelor's preferred

Tools

Windows

Word

Excel

Job description

Metropolitan Jewish Health System, Inc. seeks an experienced registered nurse to support utilization management and care coordination for Medicare/Medicaid plans. You will collaborate with Care Managers, Assessment Nurses and physicians to ensure timely services and accurate assessments.

Responsibilities include completing UAS NY assessments, updating person-centered care plans, and applying current standards of medical practice within a interdisciplinary team.