Pre-Authorization Nurse

Metropolitan Jewish Health System • New York, NY

8d • $60,673 - $75,841

About The Position

The Pre-Authorization Nurse processes requests for selected elective services, out-of-network and out-of-area requests, and durable medical equipment according to departmental criteria, regulatory standards, and Medicare guidelines. The role communicates elective hospital admissions to the appropriate Utilization Management Coordinator and/or Care Manager to support timely information and continuity of member care. It ensures authorizations are appropriate and determinations are documented to facilitate claims processing, maintain data integrity, and minimize unnecessary retrospective review. The nurse also applies program criteria to identify members for Care Management and Geriatric Case Management during pre-authorization, concurrent review, and discharge planning.

Requirements

• Graduate of an accredited Practical Nursing Program.
• Current New York LPN license and registration.
• Minimum of 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 requests, out-of-area requests, 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 made and documented to facilitate claims processing, preserve data 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- and part-time staff.
• Generous paid time off, including a birthday day off.
• Affordable and comprehensive medical, dental, and vision coverage for employees and family members.
• Two retirement plans: 403(b) and employer-paid pension.
• Flexible spending.
• Eligibility as an employer under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).
• Career development and advancement opportunities.
• Comprehensive compensation and support for work-life balance.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree