Pre-Authorization Nurse LPN

MJHS • New York, NY

7d

About The Position

Elderplan and HomeFirst are Medicare and Medicaid managed care health plans focused on helping members remain independent and live life on their own terms. The Pre-Authorization Nurse LPN processes authorization requests and supports utilization management, care coordination, and accurate documentation in accordance with departmental criteria, regulatory standards, and Medicare guidelines.

Requirements

• Graduate of an accredited Practical Nursing Program.
• Current New York LPN license and registration.
• 1–3 years of Medical/Surgical nursing experience.
• Working knowledge of Windows, Word, and Excel.
• Knowledge of current standards of medical practice and healthcare delivery systems.
• Excellent written and oral communication skills.
• Good analytical abilities.

Nice To Haves

• Prior managed care experience preferred.
• Familiarity with utilization management processes preferred.

Responsibilities

• Process requests for selected elective services, out-of-network services, out-of-area services, and durable medical equipment according to departmental criteria, regulatory standards, and Medicare guidelines.
• Communicate elective hospital admissions to the appropriate Utilization Management Coordinator and/or Care Manager to support timely receipt of information and continuity of member care.
• Ensure authorizations are appropriate and determinations are documented to facilitate claims processing, maintain data-record integrity, and minimize unnecessary retrospective review.
• Apply program criteria to identify members for Care Management and Geriatric Case Management during pre-authorization, concurrent review, and discharge planning.

Benefits

• Sign-on bonuses or student loan assistance for clinical staff.
• Tuition reimbursement for all full-time and part-time staff.
• Generous paid time off, including your birthday.
• Medical, dental, and vision coverage for employees and family members.
• Two retirement plans: 403(b) and employer-paid pension.
• Flexible spending.
• Employer qualification under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).
• Career development and opportunities for advancement.
• Work-life balance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed