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Job Description
Join MJHS as a Pre-Authorization RN and play a crucial role in enhancing the quality of life for our health plan members. Utilize your nursing expertise to ensure timely and effective healthcare services in a collaborative environment.
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
Ensure the member’s Individualized Person Centered Care Plan is updated and accurately reflects the present status of the member
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