Pre-Authorization Registered Nurse
RCM Healthcare Services
New York, NY

Pre-Authorization RN

Pre-Authorization RN
Remote after training which is a hybrid schedule
2 days onsite, 3 remote until training complete (4-6 months)
Training office is in lower Manhattan, NY
Salary: $90k - $108k + $15k Sign on Bonus

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.

Qualifications:

• Graduate of an accredited nursing program, Bachelor’s preferred
• Knowledge with Utilization management processes preferred
• Current NY RN license and registration required
• CCM preferred
• Prior Authorization or Utilization Review experience required
• 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