[Hiring] Pre-Authorization Nurse @Metropolitan Jewish Health System

Role 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.

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Responsibilities

• Process requests for selected elective services, out of network requests, out of area requests and durable medical equipment in accordance with departmental criteria, regulatory standards, and Medicare guidelines.
• Communicates all elective hospital admissions to the appropriate Utilization Management Coordinator and/or Care Manager to ensure timely receipt of information and continuity of member care.
• Ensures that authorizations are appropriate, and determinations are made and documented to facilitate claims processing, integrity of data record, and to minimize unnecessary retrospective review.
• Applies program criteria to identify members for Care Management and Geriatric Case Management during the pre-authorization, concurrent review, and discharge planning process.

Qualifications

• Graduate of an accredited Practical Nursing Program; current LPN NY license and registration required.
• Minimum of 1-3 years Medical/Surgical nursing experience; prior managed care experience preferred.
• Familiarity with Utilization management processes preferred.
• 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.

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 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).

Salary

• Min: USD $60,673.04/Yr.
• Max: USD $75,841.30/Yr.