Pre-Authorization Intake Specialist

3 weeks ago

New York, United States Metropolitan Jewish Health System Full time

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.

This position is responsible for the intake process of all Medicaid requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Pre-Authorization RN, Care Manager, Assessment Nurse and Primary Care Physician, or other Specialists, as necessary to ensure timely provision of services. Coordinate timely completion of UAS NY assessment that accurately reflects current condition of the member.

  • Baccalaureate graduate in health-related field.
  • Knowledge of Utilization management processes preferred.
  • Minimum of 3 years' experience in long term care, managed care, home care, or geriatrics.
  • Working knowledge of Medicare and Medicaid regulations, familiarity with Utilization management preferred.
  • Prior experience in an interdisciplinary service delivery environment preferred.

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