Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance! at MJHS summary:
The Pre-Authorization Registered Nurse (RN) role involves processing service requests according to Medicare and New York State Medicaid guidelines to support managed care health plans. The nurse collaborates with care managers, physicians, and specialists to ensure timely and accurate assessments and updates to individualized care plans. This position requires a current NY RN license, knowledge of utilization management, and experience in long term care or managed care environments.
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives.
Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member.
• Graduate of an accredited nursing program, Bachelor’s preferred
• Knowledge with Utilization management processes 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
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Medicare and Medicaid regulations
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Windows, Word and Excel
• Knowledge of current standards of medical practice and healthcare delivery systems
• Strong assessment skills
• Knowledge of Interqual preferred
Keywords:
Pre-Authorization RN, Medicare, Medicaid, Managed Care, Utilization Management, Care Coordination, Patient Assessment, Registered Nurse, HomeCare, Long Term Care
