Join MJHS as a Pre-Authorization RN and play a crucial role in enhancing the quality of life for our health plan members by ensuring they receive timely and appropriate services. Collaborate with a dedicated team to navigate complex healthcare regulations and support patient-centered care.
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 the Individualized Person Centered Care Plan is updated and accurate
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 in nursing
Knowledge with Utilization management processes
CCM certification
Prior experience in an interdisciplinary service delivery environment
Working knowledge of Medicare and Medicaid regulations