Pre-Authorization Nurse Job at MJHS (New York)

Pre-Authorization RN

The challenges of affordable healthcare continue to create new opportunities. El...

Location

United States , New York

Salary:

90000.00 - 110000.00 USD / Year

MJHS

Expiration Date

Until further notice

Requirements

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
Working knowledge of Windows, Word and Excel
Knowledge of current standards of medical practice and healthcare delivery systems
Strong assessment skills

Job Responsibility

Processes 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

What we offer

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, including your birthday
Affordable and comprehensive medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Flexible spending
And MORE
MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Fulltime

Rn-prior authorization/referral procedure and insurance coordinator

RN, Prior Authorization/Referral/Procedure and Insurance Coordinator functions a...

Location

United States , Des Moines

Salary:

Not provided

IntelyCare

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of nursing or IA Board of Nursing approved nursing program
Current licensure in good standing to practice as a Registered Nurse in Iowa
Valid driver's license
Basic Life Support (BLS) ceritification or obtain certification within three months from date of hire
Mandatory Report Certification
Two (2) years of RN experience

Job Responsibility

Coordinates and develops ongoing patient care, including appointments, communication, and instruction
Function as a clinician, educator and resource for patients within their specialty of care
Assist provider and clinical staff with patient prep for examinations, treatments, and minor clinic procedures
Delivers high quality care utilizing the nursing process while demonstrating knowledge and clinical skills in accordance with established policies, procedures, and standards of care throughout the clinic and across the health care continuum
Maintain flexibility by demonstrating an ability and willingness to perform a variety of duties and accept changes or additions to assignments
Thoroughly understand testing (lab and procedures) values and relationship to patient status with accountability to take next steps, as appropriate to scope and licensure
Utilize critical thinking in making independent judgements and maintains responsibility and accountability for the knowledge of conditions of assigned patients
Builds and maintains positive working relationships with patients, physicians, and all others
Perform other duties as requested by Manager of Oncology Services to facilitate the smooth and effective operations of the hosp/clinics
Maintains knowledge of clinical protocols to facilitate timely and complete work up of patients

What we offer

paid time off
parental leave
401K matching
employee recognition program
Dental and health insurance
paid holidays
short and long-term disability
pet insurance
Early access to earned wages with Daily Pay
tuition reimbursement

Fulltime

Client Partner for Clinical Review

Give your career a boost by joining us a Client Partner - Clinical Review for Pr...

Location

Philippines , Taguig City

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Ability to type at least 30 WPM
Possess basic computer knowledge
Good verbal and written communication skills
Willing to work in the night shift at our office in McKinley Hill, Taguig
Available to join immediately for full time position
Candidate must possess a Bachelor’s degree in any medical allied courses such as Nursing, Radiology, Pharmacy, Nutrition and Dietetics, Psychology, Medical Transcription, Biology, Chemistry, Medical Technology, Physical Therapy or Midwifery
Experience in a BPO healthcare setting an advantage

Job Responsibility

Be thoroughly familiar with the day-to-day activities of the Pre-Authorization process
Show the zeal and drive to learn, take initiative in equipping one-self through induction & client-specific training
Secondary level training with test scores
Update continuously your knowledge related to your client by going through mails, Knowledge Management portal
Understand the workflow process that is taking place through our IT systems
Should focus and achieve on the set targets and cooperate with the respective team in achieving the set Turn around Timekeeping a high accuracy level
Treats all patient and client information as confidential
Follow processing and client-related protocols
Process transactions as specified by Team Leader/Assistant Manager
Follow Information Security Policy and Compliance requirements including regulatory compliances

Fulltime

Supervisor Care Management Population Health

The Supervisor Care Management Population Health will support the Director of Ca...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Graduate of an accredited Registered Nursing program
Excellent computer skills needed
Experience with word processing/spreadsheets, including Excel
Excellent verbal and written skills
Minimum of five years clinical experience
Three years Case Management experience preferred
Active RN Licensure in state of employment
CCM preferred

Job Responsibility

Supports leadership with the selection, training, development, appraisal, work assignments, performance management, staffing, and productivity of Associates within Population Health Care Management
Understands and supports “Triple Aim” objectives of Population Health and promotes these objectives in concert with organizational Core Values when supervising and leading the teams
Provides formal, structured orientation/training process for new Associates with regular opportunity for feedback and assessment of competency upon completion
Collaborates with Primary Care Clinics to implement Care Coordination and/or Nurse Navigation for value-based contracts
has experience with ambulatory clinic workflow with ability to partner and troubleshoot with ambulatory clinical team to develop and refine operational workflows within the practice and specific EHR
familiar with order sets, appointment templates, scheduling of procedures, and pre-authorization
Capable of learning to navigate EHRs to thoroughly research the patient medical record to locate and identify documentation for completion of quality measures
has or can develop expertise regarding clinical knowledge of quality measures with ability to interpret definitions regarding inclusions and exclusions
Collaborates with Primary Care Clinical Team to develop and test operational workflows within specific EHR to communicate/document appropriate Home Health Case Conference information and recertification recommendations to the clinician
Ability to develop collaborative relationships with Home Health Agencies to coordinate 485 plan of care process and Case Conference scheduling

Fulltime

Licensed Practical Nurse Clinical Coordinator

At Elara Caring, we care where you are and believe the best place for your care ...

Location

United States , Jefferson City

Salary:

Not provided

Elara Caring

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of professional nursing
Current, unrestricted LPN license valid for the state of work
Minimum 1 year of experience as a nurse in a clinical setting
Must have a dependable vehicle, valid driver’s license, and current auto insurance in accordance with state laws
Ability to sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs

Job Responsibility

Promotes Elara Caring’s philosophy, mission statement and administrative policies to ensure quality of care
Reviews and clears HCHB coordination notes and processes administrative task workflows in an accurate and timely manner
Obtains orders from physicians, including verbal, written and faxed orders, and enters into appropriate system for CTM review and approval
Reviews, updates, and maintains the At-Risk registry
Provides clerical support to patients such as but not limited to scheduling follow-up appointments for patients (as requested), providing health summaries to case managers, obtaining pre-authorizations, and addressing patient questions or concerns
Performs chart audits as required by Elara Caring policy
Verifies receipt of notice of Medicare provider non-coverage to patient
Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule
May perform field visits (direct care), as needed
Performs other duties/projects as assigned

What we offer

Work in a collaborative environment
Competitive compensation package
Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost
Opportunities for advancement
Comprehensive insurance plans for medical, dental, and vision benefits
401(K) with employer match
Paid time off, paid holidays, family, and pet bereavement
Pet insurance

Fulltime

LPN Clinical Coordinator Home Health

At Elara Caring, we care where you are and believe the best place for your care ...

Location

United States , Boston

Salary:

32.00 - 38.00 USD / Hour

Elara Caring

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of professional nursing
Current, unrestricted LPN license valid for the state of work
Minimum 1 year of experience as a nurse in a clinical setting
Must have a dependable vehicle, valid driver’s license, and current auto insurance in accordance with state laws
Ability to sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs

Job Responsibility

Promotes Elara Caring’s philosophy, mission statement and administrative policies to ensure quality of care
Reviews and clears HCHB coordination notes and processes administrative task workflows in an accurate and timely manner
Obtains orders from physicians, including verbal, written and faxed orders, and enters into appropriate system for CTM review and approval
Reviews, updates, and maintains the At-Risk registry
Provides clerical support to patients such as but not limited to scheduling follow-up appointments for patients (as requested), providing health summaries to case managers, obtaining pre-authorizations, and addressing patient questions or concerns
Performs chart audits as required by Elara Caring policy
Verifies receipt of notice of Medicare provider non-coverage to patient
Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule
May perform field visits (direct care), as needed
Performs other duties/projects as assigned

What we offer

Work in a collaborative environment
Competitive compensation package
Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost
Opportunities for advancement
Comprehensive insurance plans for medical, dental, and vision benefits
401(K) with employer match
Paid time off, paid holidays, family, and pet bereavement
Pet insurance

Fulltime

Licensed Practical Nurse Clinical Coordinator

Join our elite team of healthcare professionals, providing the Right Care, at th...

Location

United States , Monroe

Salary:

Not provided

Elara Caring

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of professional nursing
Current, unrestricted LPN license valid for the state of work
Minimum 1 year of experience as a nurse in a clinical setting
Must have a dependable vehicle, valid driver’s license, and current auto insurance in accordance with state laws
Ability to sit, stand, bend, lift and move intermittently and be able to lift 50-100 lbs

Job Responsibility

Promotes Elara Caring’s philosophy, mission statement and administrative policies to ensure quality of care
Reviews and clears HCHB coordination notes and processes administrative task workflows in an accurate and timely manner
Obtains orders from physicians, including verbal, written and faxed orders, and enters into appropriate system for CTM review and approval
Reviews, updates, and maintains the At-Risk registry
Provides clerical support to patients such as but not limited to scheduling follow-up appointments for patients (as requested), providing health summaries to case managers, obtaining pre-authorizations, and addressing patient questions or concerns
Performs chart audits as required by Elara Caring policy
Verifies receipt of notice of Medicare provider non-coverage to patient
Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule
May perform field visits (direct care), as needed
Performs other duties/projects as assigned

What we offer

Tuition reimbursement for full-time staff
Continuing education opportunities for all employees at no cost
Opportunities for advancement
Comprehensive insurance plans for medical, dental, and vision benefits
401(K) with employer match
Paid time off, paid holidays, family, and pet bereavement
Pet insurance

Fulltime

New

Senior Java Software Engineer

Ready to Build Lightning-Fast Java Applications That Actually Matter? A fast-gro...

Location

Greece , Athens

Salary:

Not provided

Randstad

Expiration Date

March 05, 2026

Requirements

4+ years of relevant experience
Experience with PostgreSQL or other high-throughput databases
Familiarity with reverse proxies, load balancers (nginx, httpd)
Exposure to NoSQL tools (Elastic, Cassandra, Mongo) is a plus
Experience in container orchestration (Docker, Kubernetes) is a bonus
4+ years of hands-on experience in Java backend development
Deep knowledge of Spring, Java, and Bash scripting
Solid grasp of software security (OWASP, NIST practices)
Communication & Teamwork
Confidence

Job Responsibility

Design and build high-performing backend services with Spring Framework
Monitor and support live production systems that serve millions
Analyze performance bottlenecks, run load tests, and fine-tune systems
Collaborate with cross-functional teams to deliver scalable, secure solutions
Identify and adopt modern tools, practices, and technologies

Fulltime

Pre-Authorization Nurse

MJHS

Location:
United States , New York

Category:
Nursing

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 18, 2026

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Pre-Authorization Nurse

MJHS

Location:United States , New York

Category:Nursing

Contract Type:Employment contract

Salary:

Job Description:

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Requirements:

Nice to have:

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Job Posted:January 18, 2026

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Location:
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Contract Type:
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Job Posted:
January 18, 2026