RN Authorizing Specialist - Home Healthcare

CNSCares•Amarillo, TX

1d•Hybrid

About The Position

On behalf of CNS Cares (“CNS” or “Company”), the purpose of this position is to provide timely review of authorization requests and ensure the requests meet all applicable standards, regulatory, and contractual requirements. The RN Authorizing Specialist will use clinical knowledge and experience to promote quality patient care. The role also prepares documentation, performs audits of patient records, and coordinates with the clinical team as needed. The position is based in Amarillo, Texas, with a hybrid work schedule. It is full-time, Monday through Friday, and pays $80,000 per year or more depending on experience.

Requirements

Graduate from an accredited school of nursing.
Current Registered Nurse compact license.
At least two years of home health experience.
Valid driver’s license.
Valid and current BLS certification.
Undergo criminal background, driving record, OIG Exclusion List, and Sex Offender Registry checks.

Nice To Haves

Home health RN authorization experience strongly preferred.
Home health Department of Labor (DOL)/EEOICPA experience strongly preferred.

Responsibilities

Evaluate the medical necessity and appropriateness of ordered levels of care, using standard criteria and clinical judgment to optimize patient outcomes.
Provide accurate and complete documentation with rationale to support patient reauthorization.
Maintain a 100% monthly average of controllable submissions to DOL before the patient’s expiration date.
Maintain a 100% monthly average of completing and submitting a 60-day summary to the ordering physician.
Complete assigned chart reviews within established time frames.
Create plans of care according to state and accrediting body regulations and maintain a 100% monthly average of controllable up-to-date plans of care.
Create episodes in the electronic medical record during the renewal period.
Update the electronic medical record with authorizations within 24 hours of notification.
Request continuation of care when appropriate and enter continuation-of-care information into the electronic medical record.
Keep the renewal pipeline current with any changes daily.
Establish and promote collaborative relationships with patients, physicians, payers, and other members of the health-care team.
Collect and communicate pertinent, timely information to payers to ensure reauthorization of patients’ home health care services.
Collaborate with patients, State Administrators, and other clinical staff to coordinate patient authorization periods.
Coordinate with patients, State Administrators, and other clinical staff regarding scheduling and attending patient renewal appointments and regarding episodes in the electronic medical record.
Schedule or support scheduling all renewal appointments in the assigned region.
Participate actively in process-improvement activities to achieve optimal clinical, financial, operational, and satisfaction outcomes.
Participate in assigned quality assurance committees and interdepartmental projects when needed or requested.
Demonstrate current knowledge of payer policies and procedures.
Maintain regular attendance and punctuality, work with others at all levels of the Company, provide exceptional customer service, and demonstrate a comprehensive in-home clinical knowledge base.
Perform other duties as assigned.