About The Position
The Pre-Authorization RN processes requests for services in accordance with Medicare and New York State Medicaid guidelines, as well as departmental criteria. The role collaborates with Care Managers, Assessment Nurses, Primary Care Physicians, and other specialists to support timely service provision. It also coordinates completion of UAS NY assessments that accurately reflect members’ current conditions and ensures each member’s Individualized Person-Centered Care Plan is updated to reflect their present status.
Requirements
- Graduate of an accredited nursing program.
- Current New York RN license and registration.
- Three to five years of nursing experience in long-term care, managed care, home care, geriatrics, or hospice.
- 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.
Nice To Haves
- Bachelor’s degree preferred.
- Knowledge of utilization management processes preferred.
- CCM preferred.
- Prior experience in an interdisciplinary service delivery environment preferred.
- Knowledge of InterQual preferred.
Responsibilities
- Process service requests in accordance with Medicare and NYS Medicaid guidelines and departmental criteria and guidelines.
- Collaborate with Care Managers, Assessment Nurses, Primary Care Physicians, and other specialists to ensure timely provision of services.
- Coordinate timely completion of UAS NY assessments that accurately reflect members’ current conditions.
- Ensure members’ Individualized Person-Centered Care Plans are updated and accurately reflect their present status.
Benefits
- Sign-on bonus or student loan assistance for clinical staff.
- Free MSN in Education program.
- Tuition reimbursement for full-time and part-time staff.
- Dependent tuition reimbursement for clinical staff.
- Generous paid time off, including birthday leave.
- Medical, dental, and vision coverage for employees and family members.
- 403(b) retirement plan and employer-paid pension.
- Flexible spending account.
- Eligibility for the Federal Government’s Paid Student Loan Forgiveness Program (PSLF).
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
