Join MJHS as a Pre-Authorization RN and play a crucial role in ensuring timely and effective healthcare services for our members. Your expertise will help maintain high-quality care in 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 and accurate
Required Qualifications
Current NY RN license and registration
Graduate of an accredited nursing program
Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
Strong assessment skills
Working knowledge of Medicare and Medicaid regulations
Preferred Qualifications
Bachelor’s degree
Knowledge with Utilization management processes
CCM certification
Prior experience in an interdisciplinary service delivery environment