Join MJHS as a Pre-Authorization RN and play a vital role in enhancing the quality of healthcare services for our members. Your expertise will ensure compliance with Medicare and Medicaid guidelines while collaborating with a dedicated team to provide exceptional care.
Key Responsibilities
Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines
Collaborate with Care Managers, Assessment Nurses, and Primary Care Physicians
Coordinate timely completion of UAS NY assessments
Update and ensure accuracy of Individualized Person Centered Care Plans
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
Strong assessment skills
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