Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance!

Pre-Authorization RN - $15,000 Sign-On Bonus or Student Loan Assistance! at MJHS summary: The Pre-Authorization RN processes service requests in compliance with Medicare and Medicaid guidelines to ensure timely and appropriate care for members of managed care health plans. This role collaborates with multidisciplinary teams to coordinate assessments, update personalized care plans, and support high-quality healthcare delivery. Candidates typically hold a nursing license, have experience in long-term or managed care, and possess knowledge of utilization management and healthcare regulations. 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. 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. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures 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 with 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 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 Knowledge of Interqual preferred Keywords: pre-authorization, registered nurse, Medicare, Medicaid, managed care, care coordination, utilization management, long term care, healthcare compliance, patient assessment

Location: Hamilton, Ohio, US

Posted Date: 8/21/2025