Clinical Care Coordinator

2 weeks ago


Brooklyn, New York, United States Metropolitan Jewish Health System Full time
Job Summary

We are seeking a skilled Pre-Authorization RN to join our team at Metropolitan Jewish Health System. As a key member of our healthcare team, you will play a vital role in ensuring the timely provision of services to our members.

Key Responsibilities
  • Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines, as well as departmental criteria and guidelines.
  • Collaborate with other disciplines, including Care Manager, Assessment Nurse, and Primary Care Physician or other Specialists, to ensure timely provision of services.
  • Coordinate the timely completion of UAS NY assessments that accurately reflect the current condition of the member.
  • Ensure that the member's Individualized Person-Centered Care Plan has been updated and accurately reflects the present status of the member.
Requirements
  • Graduate of an accredited nursing program, Bachelor's preferred.
  • Knowledge with Utilization Management processes preferred.
  • Current NY RN license and registration required.
  • CCM preferred.
  • Minimum three to five years nursing experience in long-term care, managed care, home care, geriatrics, or hospice.
  • Prior experience in an interdisciplinary service delivery environment preferred.
  • Working knowledge of Medicare and Medicaid regulations.
  • Working knowledge of Windows, Word, and Excel.
  • Knowledge of current standards of medical practice and healthcare delivery systems.
  • Strong assessment skills.
  • Knowledge of Interqual preferred.


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