Pre-Authorization Nurse

Overview

• Serve as a Pre-Authorization Nurse, ensuring compliance with Medicare and Medicaid guidelines for service requests.
• Collaborate with interdisciplinary teams to provide timely and accurate healthcare services to members.
• Utilize your managed care experience to streamline care management processes and reduce interruptions.
• Work remotely after completing structured in-office and at-home training.
• Contribute to updating individualized care plans reflecting members' current status.
• Leverage strong assessment skills and knowledge of InterQual standards.
• Opportunity to transition from heavy caseload management to structured care management.
• Engage in a role that values planning and goal-oriented work processes.

Key Responsibilities & Duties

• Process service requests in alignment with Medicare and NYS Medicaid guidelines.
• Coordinate UAS NY assessments to accurately reflect members' conditions.
• Collaborate with care managers, assessment nurses, and physicians for service provision.
• Ensure care plans are updated to reflect members' current status.
• Apply knowledge of utilization management processes in managed care environments.
• Utilize Windows, Word, and Excel for documentation and reporting.
• Maintain compliance with healthcare delivery standards and regulations.
• Provide structured and goal-oriented care management services.

Job Requirements

• Associate of Applied Science (AAS) in Nursing required; Bachelor's preferred.
• Minimum of three to five years of nursing experience in relevant fields.
• Prior experience in managed care with knowledge of Medicare and Medicaid regulations.
• Strong assessment skills and familiarity with InterQual standards.
• Proficiency in Windows, Word, and Excel for documentation purposes.
• Knowledge of current medical practice standards and healthcare delivery systems.
• Experience in interdisciplinary service delivery environments preferred.
• Ability to work remotely after completing structured training.