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Pre-Authorization RN

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MJHS

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Location:
United States , New York

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

90000.00 - 110000.00 USD / Year
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Job Description:

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.

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

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
  • Knowledge of Interqual preferred

Nice to have:

  • Knowledge with Utilization management processes preferred
  • CCM preferred
  • Prior experience in an interdisciplinary service delivery environment preferred
  • Knowledge of Interqual preferred
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)

Additional Information:

Job Posted:
February 01, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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