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    Pre-Authorization RN - New York, NY, United States - MJHS Health System

    MJHS Health System
    MJHS Health System New York, NY, United States

    2 weeks ago

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    Healthcare
    Description
    Req #: 1528

    Job ID: 13103


    Job Location:
    New York, NY

    Zip Code: 10040


    Category:
    Managed Care Nursing


    Agency:
    Elderplan


    Status:
    Regular Full-Time


    Office:
    Remote after Training


    Salary:
    $85, $105,000.00 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 registered 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 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.
    Apply
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