Pre-Authorization Nurse

Responsibilities:

• 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 the current condition of the member.  
• Ensure that the members individualized person centered care plan has been updated and accurately reflects present status of the member

Qualifications:

• BGD: RN, Bach preferred
• Knowledge of UM process, 3-5 years of nursing exp
• Prior exp in managed care w knowledge of Medicare and Medicaid
• strong assessment skills – knowledge of InterQual
• 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
• Prior experience in an interdisciplinary service delivery environment preferred
• Working knowledge of Windows, Word and Excel
• Knowledge of current standards of medical practice and healthcare delivery systems
• Strong assessment skills