• Pre-Authorization RN

    Job Locations US-NY-Brooklyn
    Req #
    107252
    Agency
    Elderplan
    Status
    Regular Full-Time
    Location : Postal Code
    11220
    Category
    Managed Care Nursing
    Office or Field
    Office-based
  • Overview

    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.

    Why work for MJHS?

    When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

     

    Benefits include:

    • 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!
    • Generous paid time off
    • Affordable medical, dental and vision coverage for employee and family members
    • Two retirement plans! 403(b) AND Employer Paid Pension
    • Flexible spending
    • And MORE!

    Responsibilities

    Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member.

    Qualifications

    • 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
    • Prior experience in an interdisciplinary service delivery environment preferred
    • 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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