Pre-Authorization Nurse

4 weeks ago

New York City, United States MJHS 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.  Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

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.

  • 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.

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