Pre-Authorization RN

Base pay range

$90,000.00/yr - $/yr

Come lead with us at New York, NY

The challenges of affordable healthcare continue to create new opportunities. Elderplan and Home First, 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.

Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Work collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other specialists as necessary to ensure timely provision of services. Coordinate timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensure that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member.

• Graduate of an accredited nursing program, Bachelor’s preferred
• Knowledge of 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

Mid-Senior level

Full-time

Health Care Provider

Hospitals and Health Care