Join MJHS as a Pre-Authorization RN, where you will play a vital role in ensuring that our Medicare and Medicaid managed care health plans meet the needs of our members. Your expertise will help facilitate timely services and improve the quality of care for our patients.
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 to ensure timely provision of services
Coordinate timely completion of UAS NY assessment reflecting current condition of the member
Update and maintain the member’s Individualized Person Centered Care Plan
Required Qualifications
Graduate of an accredited nursing program
Current NY RN license and registration required
Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
Working knowledge of Medicare and Medicaid regulations
Strong assessment skills
Preferred Qualifications
Bachelor’s degree in nursing
Knowledge with Utilization management processes
CCM certification
Prior experience in an interdisciplinary service delivery environment
Working knowledge of Windows, Word and Excel
Knowledge of current standards of medical practice and healthcare delivery systems