Nursing Specialist in Managed Care

3 weeks ago

New York, New York, United States MJHS Full time

Establish a rewarding career with MJHS, a leading healthcare organization committed to delivering high-quality services.

About the Role

As a Pre-Authorization RN, you will play a critical role in ensuring timely provision of services to our members while adhering to Medicare and NYS Medicaid Guidelines. Your collaboration with other disciplines, including Care Manager, Assessment Nurse, and Primary Care Physician or other Specialists, will ensure seamless service delivery.

You will be responsible for processing requests for services, updating Individualized Person-Centered Care Plans, and coordinating the completion of UAS NY assessments that accurately reflect current member conditions.

Key Responsibilities:
  • Process all requests for services in accordance with departmental criteria and guidelines;
  • Collaborate with interdisciplinary teams to ensure timely provision of services;
  • Coordinate completion of UAS NY assessments that accurately reflect current member conditions;
  • Ensure Individualized Person-Centered Care Plans are updated and reflect present member status.
About Us

MJHS companies, including Elderplan and HomeFirst, offer outstanding examples of expanding services in response to patient and member needs. Our Medicare and Medicaid managed care health plans aim to keep people independent and living life on their own terms.

Benefits

We offer an array of benefits designed to support your career growth and well-being:

  • Comprehensive and affordable health and financial benefits;
  • Generous paid vacation, personal, and holiday time;
  • Training, tuition assistance, and career development opportunities;
  • Sign-on Bonuses OR Student Loan Assistance for clinical staff;
  • FREE Online RN to BSN and MSN degree programs;
  • Tuition Reimbursement for all full and part-time staff;
  • Dependent Tuition Reimbursement for clinical staff;
  • Affordable medical, dental, and vision coverage for employees and family members;
  • Two retirement plans (403(b) AND Employer Paid Pension);
  • Flexible spending options;
  • Paid Student Loan Forgiveness Program eligibility.
About Our Location

New York is a hub for diverse industries, offering endless opportunities for professional growth and development. With a strong focus on work-life balance, we encourage our team members to explore the city's vibrant culture and attractions outside of work hours.

Salary

The estimated salary range for this position is $90,000 - $110,000 per year, based on industry standards and location.

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