Pre-Authorization Nurse Supervisor

5 days ago


New York, New York, United States RCM Health Care Services Full time
Job Summary

The Pre-Authorization Nurse Supervisor is responsible for overseeing the day-to-day operations of the Pre-Authorization Unit at RCM Health Care Services. This role involves reviewing data to ensure compliance with regulatory requirements, providing guidance on complex cases, and monitoring pending cases. The successful candidate will have a strong background in nursing and management, with experience in utilization management and case management.

Key Responsibilities
  • Oversee the Pre-Authorization Unit's daily operations, ensuring compliance with regulatory requirements
  • Review data to monitor regulatory requirements, including standard and expedited time frames, organization determination outcomes, and communication
  • Provide guidance on complex cases and monitor pending cases
  • Review and educate staff on new criteria trends, including InterQual, local carrier policy, and national coverage determinations
  • Act as a liaison with interdepartmental communication
Requirements
  • Graduate of an accredited nursing program, baccalaureate degree preferred
  • Minimum one to three years' previous management experience, preferably in managed care
  • Previous experience in utilization management and/or case management
  • Minimum one year nursing practice in clinical settings, such as hospitals, nursing facilities, or home health
  • Licensed to practice as a Registered Nurse in the state of New York with current registration
  • CCM certification preferred
  • Knowledge of InterQual and Federal and State regulatory requirements for managed care
Benefits
  • Tuition Reimbursement for all full and part-time staff
  • Generous paid time off
  • Affordable medical, dental, and vision coverage for employees and family members
  • Two retirement plans, 403(b) and Employer Paid Pension
  • Flexible spending


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