Join MJHS as a Pre-Authorization RN, where you will play a vital role in processing service requests and collaborating with healthcare professionals to enhance the quality of care for our members. This position offers an opportunity to make a significant impact on the lives of patients within our Medicare and Medicaid managed care health plans.
Key Responsibilities
Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines
Collaborate with Care Manager, Assessment Nurse, and Primary Care Physician
Coordinate timely completion of UAS NY assessment
Ensure Individualized Person Centered Care Plan is updated
Required Qualifications
Graduate of an accredited nursing program
Current NY RN license and registration
Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
Preferred Qualifications
Bachelor’s degree
Knowledge with Utilization management processes
CCM certification
Prior experience in an interdisciplinary service delivery environment
Working knowledge of Medicare and Medicaid regulations