Pre-Authorization Nurse

Overview

• Join a leading healthcare organization as a Pre-Authorization Nurse, ensuring compliance with regulatory guidelines for service requests.
• Collaborate with interdisciplinary teams to deliver timely, accurate healthcare services to members.
• Leverage your managed care expertise to enhance care management processes and reduce service interruptions.
• Enjoy remote work opportunities following structured in-office and at-home training.
• Contribute to updating individualized care plans reflecting members' current health status.
• Utilize strong assessment skills and knowledge of InterQual standards to ensure quality care.
• Transition from heavy caseload management to a structured, goal-oriented care management role.
• Engage in a position that values planning and efficient work processes.

Key Responsibilities & Duties

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

Job Requirements

• Associate of Applied Science (AAS) in Nursing required; Bachelor's degree preferred.
• Minimum of two years of nursing experience in relevant fields.
• 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 following structured training completion.