Pre-Authorization Nurse

Req # : 2346

2346

Job ID : 13865

13865

Job Location : New York, NY

New York, NY

Zip Code : 10041

10041

Category : Managed Care Nursing

Managed Care Nursing

Agency : Elderplan

Elderplan

Status : Regular Full-Time

Regular Full-Time

Office : Hybrid

Hybrid

Salary :

$80,239.90 - $100,299.88 per year

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.

These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

Why work for MJHS? :

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors.

Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.

You take care of our patients, residents and health plan members, and we will take care of the rest!

Benefits include :

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off
• Affordable medical, dental and vision coverage for employee and family members
• Two retirement plans ! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF)

Responsibilities :

The position requires the nurse to perform case reviews and process all requests for elective services and durable medical equipment in accordance with the Center for Medicare and Medicaid Guidelines, New York State Medicaid Guidelines, evidence-based Best Practice Guidelines, as well as other departmental criteria and protocols.

Works collaboratively with other disciplines within and outside of the department including Physician Advisors, Vendors, Providers, Member's Primary Care Physicians, and other Specialists as necessary to ensure compliance with regulatory standards and timely provision of services.

The registered Nurse will provide high-quality customer service.

Qualifications :

• Graduate of an accredited Nursing Program. Bachelors preferred.
• Current New York State RN or LPN License required.
• A minimum of two years of clinical experience is preferred; relevant managed care healthcare experience may be considered in lieu of clinical nursing experience.
• Knowledge of Utilization management processes is required.
• Prior managed care experience is required.
• Working knowledge of Medicare and Medicaid regulations is required.
• Knowledge of current standards of medical practice and healthcare delivery systems.
• Working knowledge of Windows, Word, and Excel.
• Excellent written and oral communication skills.
• Ability to manage multiple priorities, effective organizational, and time management skills.
• Good analytic abilities.
3 hours ago